ASCEND 2022 | REGISTRATION

ASCEND 2023 | STUDENT REGISTRATION
Full Name*

First Name Last Name
Sex*

MaleFemale
E-mail*
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number*

Area Code Phone Number
Birth Date*

Month Day Year

What College/University do you attend?
If 'other', please let us know what College/University you attend here:
What college year are you in?
Did you attend ASCEND 2022?*

YesNo

Medical Information

Your health is very important to us. We want to be sure that we can serve you well during our program. The information provided will be handled confidentially.
Do you have any physical impairments and/or limitations, or require special assistance to attend/participate in ASCEND?*
If yes, please provide details here. You will be contacted by a member of staff to discuss your specific needs.
Do you have any food or medical allergies?*
If yes, please explain:
Emergency Contact Information
In an emergency, please contact:*
Phone number: (cell or home)*
Relationship to registrant:*

Assumption of Risk/Release of Liability
COVID-19 Waiver

By checking the below box, I understand and agree that the ASCEND Conference on Jan 3 - 6, 2023 and held at the Wyndham Hotel in Orlando, Florida, hosted by St. Paul’s Outreach, Inc. (herein after referred to as “SPO”) of which I am a participant, involves certain risks due to the COVID-19 pandemic.

While SPO is taking certain precautions, it is possible that some participants including me will be exposed to and possibly catch the virus. This might happen while traveling to or from the event, or while attending the retreat.

Knowing this information, in consideration of my participation in the above event:
- I expressly and knowingly release SPO and their officers, agents, representatives, advisors, directors, family members, volunteers, helpers, partners, associates and employees from any and all claims and causes of action arising from my contracting the novel coronavirus COVID-19 and/or arising out of any travel or activity conducted by or under the auspices of SPO, caused by the risk associated by this activity and /or the negligence of SPO.
- In addition, I understand and agree that SPO cannot be expected to control the risks articulated in this form, but may need to respond to potential emergency situations. Therefore, I hereby give my consent for any medical treatment that may be required during my participation with the understanding that the cost of any such treatment will be my responsibility. SPO does not carry medical or accident insurance for the novel coronavirus COVID-19, unless the participants are informed otherwise. As such, participants should review their personal insurance portfolio.
- Finally, I voluntarily and knowingly agree to defend, protect, hold harmless, and fully indemnify, SPO. This includes: its officers, agents, representatives, advisors, directors, family members, volunteers, helpers, partners, associates and employees against all claims, demands, or causes of action for anything, arising from the negligence or fault of SPO, including defense costs and attorney fees arising out of my participation in the above retreat hosted by SPO.
- I represent that I am eighteen (18) years of age or older and otherwise competent to execute this agreement, (otherwise you may not attend this event).
Assumption of Risk/Release of Liability

By checking the below box, I hereby agree to release Saint Paul's Outreach (SPO), its representatives, agents, servants and employees from liability for any injury resulting from any cause whatsoever occurring to me at any time while attending the conference in my location, including travel to and from the conference, excepting only such injury or damage resulting from grossly negligent or intentional acts of SPO, its agents, servants and employees.

I voluntarily assume all other risks and danger relating to the conference, whether occurring prior to, during or after the event. I do voluntarily authorize SPO and/or its designees to administer and/or obtain emergency diagnostic procedures or emergency medical treatment for me as deemed necessary in medical judgment. Any further treatment will require my consultation.
Photography and Sound Release

By my attendance at the conference, I hereby grant Saint Paul's Outreach (SPO) permission to make still or motion pictures and sound recordings of the conference and any related events featuring my image and/or words, separately or in combination, and also give a production and/or recording company approved by SPO permission to use the finished silent or sound pictures and/or sound recordings as deemed necessary or helpful.

Further, I so hereby relinquish to SPO all rights, title, interest in and income from the finished sound or silent motion pictures, still pictures, sound recordings, negatives, prints, reproductions and copies of the originals, negatives, recording duplicates and prints that contain my image and/or words, and further grant SPO the right to give, sell, transfer and/or exhibit the same to any individual, business firm, publication, television station, radio station or network, or governmental agency, or to any of their assignees, without payment or other consideration to me.
COVID-19/Assumption of Risk/Photo & Video Release*

I agree to all of the above

Household
If you are living in an SPO Household that is rolling ASCEND into Household fees, please select your chapter below. *
Choose 'I am not going to live in one of these HHs' if this does not apply to you.

ASCEND Payment
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How would you like to pay for ASCEND?*

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ASCEND 2023 | STUDENT REGISTRATION

Assumption of Risk/Release of Liability

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