Broom Tree Retreat 2024

Broom Tree Retreat 2024

Chaperone Registration
General Information
Name*

First NameLast Name
Sex*

MaleFemale
Birthdate*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Parish, Town*
Phone Number*
Preferred Email for Retreat Communications*
Please enter an email that is checked regularly.
Emergency Contact Information
Contact #1 Name*

First NameLast Name
Contact #1 Phone Number*
Relationship to you*
Contact #2 Name*

First NameLast Name
Contact #2 Phone Number*
Relationship to you*
Medical Information
Allergies
Only list relevant allergies, such as food or medications.
Medical Conditions
Only list relevant medical conditions.
Emergency Medical Treatment

Liability Waiver & Code of Conduct
Liability Waiver
I, First Name* Last Name* , will participate in the Broom Tree Retreat of 2024. In consideration for allowing my participation in this event/activity, I agree on behalf of myself and my heirs, successors, and assigns to hold harmless, release, discharge, and defend the Diocese of New Ulm and all parishes and schools within the Diocese, and the officers, directors, agents, representatives, volunteers, and employees of either the Diocese or any parish and school thereof, and chaperones or representatives associated with the Broom Tree Retreat 2024 with respect to any and all actions, claims, demands, and legal liability, whether the same be known or unknown, anticipated or unanticipated, due to the ordinary negligence of the Diocese of New Ulm or its parishes and schools within the Diocese, and the officers, directors, agents, representatives, volunteers, and employees thereof that may be made or brought against the Diocese of New Ulm and any parishes or schools within the Diocese, and the officers, agents, representatives, volunteers, and employees of either the Diocese or any parish or school thereof, and chaperones or representatives associated with the Broom Tree Retreat 2024, arising from or in connection therewith, and I do further agree that except in the event of gross negligence and willful and wanton misconduct, I shall not bring any actions, claims, demands, or legal actions against the Diocese of New Ulm or any parishes or schools within the Diocese, or the officers, agents, representatives, volunteers, and employees of either the Diocese or any parish or school thereof, and chaperones or representatives associated with the Broom Tree Retreat 2024, as stated herein, for any economic and non-economic losses due to bodily or personal injury, death, or property damage sustained by me in relation to the Broom Tree Retreat 2024.
Code of Conduct & Signature
Signature*

Clear
Date*

MonthDayYear
Date

You're almost done!

We just need one more thing for our records...
How will you be paying?*
NOTE: If you are paying for multiple retreatants, please specify this at checkout.
***Upon registration, you will be redirected to the Broom Tree Retreat registration page and sent a confirmation email.***

The email will contain additional retreat information.
Should be Empty:

Broom Tree Retreat 2024

General Information

Emergency Contact Information

Medical Information

Emergency Medical Treatment

Liability Waiver & Code of Conduct

Liability Waiver

Code of Conduct & Signature

You're almost done!

***Upon registration, you will be redirected to the Broom Tree Retreat registration page and sent a confirmation email.***

Upon registration, you will be redirected to the Broom Tree Retreat registration page and sent a confirmation email.