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Shalom Retreat Center Release of Liability
*
Indicates required field
Name
*
First
Last
[object Object]
Who are you completing this for?
*
Adult
Minor
Family
If Minor: Name of Minor
*
First
Last
If Family: Name of Family Representative
*
First
Last
Arrival Date
*
Departure Date
*
RELEASE & WAIVER
Do you understand that you are responsible for exercising good judgment and that Shalom Retreat Center is not responsible for your safety?
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Yes
No
Do you release, waive, and hold harmless Shalom Retreat Center and each of their employees and agents, from any liability for loss of property or for illness (including COVID-19) or personal injury that may occur during the above mentioned time period?
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Yes
No
MEDICAL TREATMENT
Do you give Shalom Retreat Center staff members permission to authorize any needed medical treatment and do you agree to pay all costs from this action to obtain medical treatment?
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Yes
No
PHOTOS
Do you give Shalom Retreat Center permission to take your photo for advertising or marketing material?
*
Yes
No
AGREEMENT
By typing your name below you acknowledge that you read, understood, and agree to the above terms and that you are either 18 or older or are signing on behalf of a minor.
*
DATE
Please provide the date that you completed this form.
*
Submit
Home
Book
Book A Retreat
>
Facility Use Agreement
Release Form
Preparation
Cost & Payment
Upcoming Events
Our Property
Lodging
Gathering Spaces
Activities
Benefit
About
Our Heritage
Our Staff
Our Partners & Friends
Give
Volunteer Opportunities
Contact Us
Blog
COVID-19
