Silent Retreat Registration Please complete the form below in order to let us know you are coming. Silent Retreat Registration Name* First Last Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Please read and acknowledge your agreement to the liability waiver below: Revelation Retreats Assumption of Risk, Release of Liability, and Consent to Medical Care Revelation Retreats (hereinafter “Revelation”) operates retreat-related programs in Jefferson, Colorado (hereinafter “Retreat”). Participation in a Retreat may involve certain activities, which could include, but is not limited to: Traveling, residing, and hiking in remote, mountainous environments; pool and water activities, such as swimming, and rafting; archery; shooting; rock climbing; campfires; snowshoeing; transportation to and from the Retreat and to other locations during the Retreat; and other similar sport or leisure activities (together with all other activities during the Retreat, the “Activities”). The Activities have inherent risks and dangers, including, but not limited to: slips, trips, and falls due to facility or terrain conditions, including icy or slippery surfaces; high altitude; exposure to adverse weather conditions, wildlife, fire, cliffs, and landslides; errors in supervision and maintenance; defects in equipment, roadways, and trails; and distance from medical attention. By signing below, you are agreeing to the terms and conditions of this Agreement in exchange for the opportunity to participate in the Activities. Assumption of Risk. By executing this Agreement, I understand that participation in the Activities involves the risk of illness and serious personal injury, including permanent disability and death. I fully and voluntarily assume the risks associated with participating in the Activities. I also attest that I am in good health and appropriate physical condition to participate safely in the Activities. Release of Liability and Indemnification. In consideration for the privilege of participating in the Activities, I hereby release, indemnify, and covenant not to sue Revelation and Revelation Ranch Holdings, LLC, their related organizations, and all of their directors, officers, employees, agents, and volunteers (collectively, hereinafter the “Released Parties”), of and from any and all demands, claims, liabilities, legal causes of action, known or unknown, that arise directly or indirectly from my participation in the Activities, and that involve property damage, economic loss, or personal injury (physical or mental). The foregoing sentence shall apply, without limitation, to all demands, claims, and liabilities involving theReleased Parties’ negligence, but not to willful and wanton, reckless, or grossly negligent acts or omissions. Consent to Medical Care. In the event that I become injured or ill, and neither I nor the emergency contact listed below are available to consent to medical care, I authorize Revelation to arrange for any medical care it deems necessary or advisable. I agree to pay the costs of any such medical care arranged and I hereby release and waive any claims or causes of action and agree not sue the Released Parties based on the negligent, wanton or willful acts of any medical provider who provides medical services to me. Miscellaneous. If any provision of this Agreement is determined to be invalid for any reason, such invalidity shall not affect the validity of any other provision. I understand and agree that this Agreement is intended to be as broad and inclusive as permitted under applicable law. Check below you have read this agreement* BY SIGNING BELOW, I ATTEST AS FOLLOWS: I HAVE READ THIS AGREEMENT CAREFULLY, UNDERSTAND ITS TERMS, AND SIGN IT FREELY AND VOLUNTARILY AND INTENDING IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. Signature*CAPTCHA Δ