ECHO Marriage Retreat

1
HUSBAND'S INFO
First Name
Last Name
Age at the Time of Retreat
Email Address
Please list any medical or environmental allergies we should be aware of as well as any dietary restrictions..
2
WIFE'S INFO
First Name
Last Name
Age at the Time of Retreat
Email Address
Please list any medical or environmental allergies we should be aware of as well as any dietary restrictions..
3
CONTACT NUMBERWho should be our primary contact?
Husband
Wife
Phone Number
4
EMERGENCY CONTACT* This field is required.In case of an emergency, please list a someone who will be off-site at the time of the retreat you would like us to contact.
Name of Emergency Contact
Phone Number
Relationship to Couple
5
MAILING ADDRESS* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
6
HOW MANY YEARS HAVE YOU BEEN MARRIED?* This field is required.
7
PAST ECHO EXPERIENCE
Yes
No
Have you or your child ever attended an ECHO Retreat in the past?
If you answered "yes" above, please list any past ECHO experiences you or your child has attended..
8
HOW WOULD YOU DESCRIBE YOUR KNOWLEDGE OF THE THEOLOGY OF THE BODY AS A COUPLE?* This field is required.(There is no wrong answer)
"I can quote it"
"I get the gist"
"I've heard of it"
"What's that?"
9
HUSBAND - MEDICAL LIABILITY WAIVER* This field is required.I hereby authorize Dumb Ox Ministries to carry out the wishes I have named (herein) in areas of emergency medical treatment and other cases of illness for myself. This authorization inclusively extends from October 21-23, 2022. I hereby warrant, to the best of my knowledge, I am in good health, and I assume all responsibility for myself.In the event of an emergency, I hereby give permission to transport me to a hospital for emergency medical or surgical treatment. I ask you to advise my spouse and the person(s) listed as the emergency contact to any further treatment by the hospital or doctor. I assume full financial responsibility for any medical treatment expenses I may incur. I agree to either pay for services upfront, or if Dumb Ox Ministries pays, I agree to be billed and reimburse their expense.
10
WIFE - MEDICAL LIABILITY WAIVER* This field is required.I hereby authorize Dumb Ox Ministries to carry out the wishes I have named (herein) in areas of emergency medical treatment and other cases of illness for myself. This authorization inclusively extends from October 21-23, 2022. I hereby warrant, to the best of my knowledge, I am in good health, and I assume all responsibility for myself.In the event of an emergency, I hereby give permission to transport me to a hospital for emergency medical or surgical treatment. I ask you to advise my spouse and the person(s) listed as the emergency contact to any further treatment by the hospital or doctor. I assume full financial responsibility for any medical treatment expenses I may incur. I agree to either pay for services upfront, or if Dumb Ox Ministries pays, I agree to be billed and reimburse their expense.
11
HUSBAND - GENERAL LIABILITY WAIVER* This field is required.I understand that I remain legally responsible for any personal actions. I agree on behalf of myself, heirs, successors, and assigns, to hold harmless and defend Dumb Ox Ministries, the Diocese of Houma-Thibodeaux, Lumen Christi Retreat Center, their officers, directors, agents and staff, or representatives associated with the event, arising from or in connection with my attending the event or in connection with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate Dumb Ox Ministries, the Diocese of Houma-Thibodeaux, Lumen Christi Retreat Center, their officers, directors, staff, agents, or representatives associated with the activity for reasonable attorney fees and expenses arising in connection therewith.
12
WIFE - GENERAL LIABILITY WAIVER* This field is required.I understand that I remain legally responsible for any personal actions. I agree on behalf of myself, heirs, successors, and assigns, to hold harmless and defend Dumb Ox Ministries, the Diocese of Houma-Thibodeaux, Lumen Christi Retreat Center, their officers, directors, agents and staff, or representatives associated with the event, arising from or in connection with my attending the event or in connection with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate Dumb Ox Ministries, the Diocese of Houma-Thibodeaux, Lumen Christi Retreat Center, their officers, directors, staff, agents, or representatives associated with the activity for reasonable attorney fees and expenses arising in connection therewith.
13
HUSBAND - COVID-19 WAIVER* This field is required.In the unprecedented times of COVID-19, Dumb Ox Ministries recognizes the additional potential risks posed by the virus and its high infection rate. Our program participants are required to read the protocols that follow and follow all protocols throughout their time to promote their safety and the safety of the other program participants, hosts, Dumb Ox staff, and those with whom they will interact at Dumb Ox events. (1) I agree to follow all safety protocols as recommended by the CDC in regards to COVID-19. I also agree to follow those recommendations specific to Louisiana as laid out by the office of the governor, as the reopening of the state progresses. Dumb Ox Ministries may also add additional safety protocols to these lists as it sees fit. (2) I agree to follow all safety protocols for the duration of the event, at all times and in all places, including but not limited to, the properties of Lumen Christi Retreat Center. (3) I agree to hold Dumb Ox Ministries, its staff, its board of directors, its volunteers (including any hosts or host families), its program participants, and its insurers harmless from and against any and all liability, claims, demands, lawsuits, and expenses arising from personal injury, sickness, death, or property damage, including any costs related to medical treatment or injuries resulting from a COVID-19 infection. (4) I am aware that COVID-19 is highly contagious and I agree to assist Dumb Ox in taking these precautions for my safety and that of others.
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WIFE - COVID-19 WAIVER* This field is required.In the unprecedented times of COVID-19, Dumb Ox Ministries recognizes the additional potential risks posed by the virus and its high infection rate. Our program participants are required to read the protocols that follow and follow all protocols throughout their time to promote their safety and the safety of the other program participants, hosts, Dumb Ox staff, and those with whom they will interact at Dumb Ox events. (1) I agree to follow all safety protocols as recommended by the CDC in regards to COVID-19. I also agree to follow those recommendations specific to Louisiana as laid out by the office of the governor, as the reopening of the state progresses. Dumb Ox Ministries may also add additional safety protocols to these lists as it sees fit. (2) I agree to follow all safety protocols for the duration of the event, at all times and in all places, including but not limited to, the properties of Lumen Christi Retreat Center. (3) I agree to hold Dumb Ox Ministries, its staff, its board of directors, its volunteers (including any hosts or host families), its program participants, and its insurers harmless from and against any and all liability, claims, demands, lawsuits, and expenses arising from personal injury, sickness, death, or property damage, including any costs related to medical treatment or injuries resulting from a COVID-19 infection. (4) I am aware that COVID-19 is highly contagious and I agree to assist Dumb Ox in taking these precautions for my safety and that of others.
15
HUSBAND - PHOTO RELEASE & VIDEO CONSENT* This field is required.In consideration of the taking and use of the photographs or video footage of the named below, for good and valuable consideration herein acknowledged as received, I hereby grant to Dumb Ox Ministries the irrevocable and unrestricted right and permission to take, use, re-use, publish photographic pictures of me or those of which I may be included, made through any medium and in any and all media now or hereafter known for illustration, promotion, art, editorial, advertising, trade, or any other purpose whatsoever. I also consent to the use of any published matter in conjunction therewith. I hereby waive any right that I may have to inspect or approve the finished product or products and the advertising copy or another matter that may be used in connection therewith or the use to which it may be applied. In exchange for the benefits derived by my participation, I hereby agree that I, my heirs, distributes, guardians, legal representatives, and assigns to do release and will indemnify, hold harmless the photographer or videographer, Dumb Ox Ministries for claims for libel or violation of any right of publicity or privacy or privacy arising out of or in connection with my participation in the photography or videography project, from whatever cause, including the active or passive negligence of the photographer, videographer, or Dumb Ox Ministries.
16
WIFE - PHOTO RELEASE & VIDEO CONSENT* This field is required.In consideration of the taking and use of the photographs or video footage of the named below, for good and valuable consideration herein acknowledged as received, I hereby grant to Dumb Ox Ministries the irrevocable and unrestricted right and permission to take, use, re-use, publish photographic pictures of me or those of which I may be included, made through any medium and in any and all media now or hereafter known for illustration, promotion, art, editorial, advertising, trade, or any other purpose whatsoever. I also consent to the use of any published matter in conjunction therewith. I hereby waive any right that I may have to inspect or approve the finished product or products and the advertising copy or another matter that may be used in connection therewith or the use to which it may be applied. In exchange for the benefits derived by my participation, I hereby agree that I, my heirs, distributes, guardians, legal representatives, and assigns to do release and will indemnify, hold harmless the photographer or videographer, Dumb Ox Ministries for claims for libel or violation of any right of publicity or privacy or privacy arising out of or in connection with my participation in the photography or videography project, from whatever cause, including the active or passive negligence of the photographer, videographer, or Dumb Ox Ministries.
17
CANCELLATION POLICY* This field is required.1. I understand that the deposit is non-refundable. If cancellation occurs before Friday, October 7, 2022 (10 business days prior to the retreat), I understand that I can be refunded any fees paid except for the deposit. 2. I understand that if cancellation occurs for any reason after Friday, October 7, 2022, I am unable to receive any refunds and I will still be responsible for the full registration fees. 3. I understand that any cancellations concerning COVID-19 should be communicated to Dumb Ox Ministries in as timely a manner as possible.
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ECHO REGISTRATION FEES:

ECHO RETREAT COST:
$500 per couple (Due by October 7, 2022)

*You must at least pay your deposit of $150 to confirm your spot.

*Registration cost covers all food, lodging, and retreat supplies.

*We do offer customizable payment plans, fundraising tools, and limited scholarships to those in need. Email us at echo@dumboxministries.com to inquire.
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PAYMENT METHODSWe are able to accept online payments via credit/debit cards as well as mail-in checks.
I will pay my $150 deposit online now via credit/debit card, and remaining balance by Oct. 7th.
I will pay my $150 deposit via mail-in check, and remaining balance by Oct. 7th.
I will pay in full now via credit/debit card.
I will pay in full via mail-in check.
Please select your preferred payment method
20
HUSBAND - SIGNATURE OF AGREEMENT* This field is required.By signing below, you agree to all the terms and conditions listed in the above Medical Liability Waiver, General Liability Waiver, COVID-19 Waiver, ECHO Code of Conduct, and the Cancellation Policy.
Clear
21
WIFE - SIGNATURE OF AGREEMENT* This field is required.By signing below, you agree to all the terms and conditions listed in the above Medical Liability Waiver, General Liability Waiver, COVID-19 Waiver, ECHO Code of Conduct, and the Cancellation Policy.
Clear
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HOW DID YOU HEAR ABOUT ECHO?* This field is required.
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A Friend Told Me About It
Printed Advertisement
Social Media Post
23
PLEASE READ BEFORE SUBMITTING!

Upon clicking submit, you will be redirected to a payment page to pay via credit/debit card.

If you selected to pay via check, disregard the following screen, make your check out to Dumb Ox Ministries, and mail it to:

Dumb Ox Ministries
P.O. Box 251
Mandeville, LA 70470

You must pay at least the $150 deposit to confirm your spots.

We never want money to be the reason you cannot attend one of our events. If you have a financial hardship, please contact us. We will be happy to discuss options to help you attend.

Contact us at (985) 951-2215 or at echo@dumboxministries.com with any questions or concerns.

Upon reviewing your registration, we will send you a confirmation email along with a packing list, so please be on the lookout for that.
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