College Retreat Registration - Archangel Michael

Registrant Information

Registrant *

First

Last

Cell Phone Number *

Email *

Email

Confirm Email

Date of Birth *

Gender *

Male
Female

*Windbreaker Size (Runs Big) *

*Register before December 30th for a free windbreaker. Submittions after December 30th will receive a windbreaker but on a date after the retreat.

Emergency Contact Information

Name *

First

Last

Relationship to Registrant *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Additional Information

What do you hope to get out of your retreat?

Medical Conditions or Dietary Restrictions

Waiver

I recognize that there are risks involved in participating in this activity and hereby assume all risk of injury, harm, damage, or death in connection with my participation in this activity. I understand and agree that neither Archangel Michael Coptic Orthodox Church in Santa Ana (“Archangel Michael Church”) nor its priests, trustees, officers, directors, employees, servants, agents or representatives may be held liable in any way for any injury, harm, damage, or death that may occur to me as a result of my participation in this activity and hereby release Archangel Michael Church, its priests, trustees, officers, directors, employees, agents and representatives from any injury, harm, damage or death, which may occur while I am participating in the activity. To the fullest extent permitted by law, I agree to save and hold harmless Archangel Michael Church, its priests, trustees, officers, directors, employees, servants, agents and representatives from any claim by myself, my estate, heirs, successors, assigns or other persons arising out of my participation in the activity. I authorize Archangel Michael Church through its priests, trustees, officers, directors, employees, servants, agents or representatives to render or obtain such emergency medical care or treatment for me as may be necessary should any injury, harm or accident occur to me while participating in this activity. I understand and acknowledge that Archangel Michael Church does not provide health or medical insurance in connection with the activity and I agree that I will be financially responsible for any bills incurred as a result of medical treatment, including emergency medical treatment and/or transportation to a medical facility, in connection with my participation in the activity. *

Price: $125.00

*Price will rise to $150 after December 30th