Chapter Retreat Registration

Overdressed - 2012 Chapter Retreat

Details about this year's retreat
Please fill out the registration form below, or print this form and turn in at large group.
Even if you register online, you will still need to pay in cash or check made out to I.V.C.F.
Questions about scholarships, etc., email Beth at beth_gambardella@ivstaff.org.

CNU IV's Chapter Retreat Registration

Name *

First

Last

Email *

Phone Number *

Gender *

Class *

Check those that apply: *

I will be arriving late to retreat on Friday or Saturday I will be leaving retreat early on Saturday or Sunday I prefer vegetarian meals I have the following dietary needs

Dietary Needs: *

Individual Release

In consideration for being accepted and allowed to participate in this conference/project and activities associated with its program and location, I personally assume responsibility for my actions, and release InterVarsity Christian Fellowship/USA® (hereafter InterVarsity®), its Trustees, employees and agents from loss, injury or damage to myself or my property; provided that nothing contained herein shall excuse InterVarsity, its Trustees, employees or agents from responsibility to act with reasonable care for the safety of myself or my property. I give permission to InterVarsity to be photographed, recorded, and/or video taped & I allow this material to be used for publicity.

I give permission to InterVarsity to obtain medical assistance in the event of an emergency. This permission will include the administration of medicines, surgical treatment, X-ray examination or hospitalization as might be ordered by a licensed medical doctor. I release and discharge InterVarsity, its trustees, employees, and agents from any liability for any first aid rendered or treatment performed pursuant to this consent.

Any claim or dispute arising from or related to this release shall be settled by mediation and, if necessary, legally binding arbitration in accordance with the Rules of Procedure for Christian Conciliation of the Institute for Christian Conciliation, a division of Peacemaker® Ministries (complete text of the Rules is available at www.HisPeace.org). Judgment upon an arbitration decision may be entered in any court otherwise having jurisdiction. I understand that these methods shall be the sole remedy for any controversy or claim arising out of this release and expressly waive my right to file a lawsuit in any civil court against InterVarsity for such disputes, except to enforce an arbitration decision. I certify that I am competent to sign this Release, and have done so voluntarily.

Signature of Participant *

Date *

In Case of Emergency:

Parent or Guardian's Name *

Parent or Guardian's Phone Number *

Payment *

I will pay the entire cost of $60 upon arriving at camp I will pay part of the cost and am requesting the amount of scholarship money below I am requesting the scholarship amount listed below

Amount of scholarship money requested and/or other things we should know: *

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