Antioch Retreat Individual Registration Form

MEDIA RELEASE AND CONSENT

I hereby give the Franciscan Renewal Center (“FRC”) and its licensees, including organizers and sponsors of events in which the Antioch Group participates, the right to photograph, film, record, or capture, my name, image, voice, statements, and likeness (collectively "Likeness") and the Likeness of members of my family (including my children), whose names are listed below (collectively “Family Members”).  I further consent to the use, reuse, reproduction, license, display, and publication of such Likeness without restriction, in any and all media now known or hereafter devised throughout the universe in perpetuity for any purpose whatsoever in connection with the promotion of the FRC, including without limitation any commercial or noncommercial use on websites, social media, news or advertising. I understand that my Likeness and the Likeness of my Family Members may be combined with other images, videos, text, and/or graphics and may be cropped, altered, or modified. I hereby hold the FRC and its licensees harmless and forever waive and release any claims against the FRC and their licensees based on any rights of privacy, publicity, defamation, copyright infringement or any other right that may arise from or be related to the use, exhibition, license, modification, distribution, publication, or reproduction of my Likeness or the Likeness of my Family Members. I understand that no compensation will be provided to me or my Family Members for or in connection with any use of our Likeness. I represent and warrant that I am at least 18 years of age and able to provide this consent.

Activity/Event: The Antioch Retreat (the “Activity”)

Date of Activity/Event:  January 12, 2025

Location of Activity/Event: On the Franciscan Renewal Center grounds, Scottsdale, AZ

Transportation:  I understand and acknowledge that transportation arrangements to and from the Franciscan Renewal Center are my responsibility, whether my teen travels in my own personal vehicle or with another individual(s). I additionally understand and acknowledge that in the event that my teen travels in my own personal vehicle, I agree that I am responsible for my own acts and for the safety and security of my own vehicle.  I accept full responsibility for the liability of myself and my passengers, and I understand that, if my teen is a passenger in a private vehicle, the Franciscan Renewal Center is not in any way responsible for the safety of such transportation.  I further agree that the Franciscan Renewal Center's insurance does not cover any damage or injury suffered in the course of traveling in a private vehicle.

Assumption of Risks: I understand that participation in this Activity carries with it certain risks and hazards directly or inherently involved that cannot be eliminated regardless of the care taken to avoid injuries: The risks include but are not limited to: 1) minor injuries such as scratches, bruises, and sprains; and 2) major injuries such as joint or back injuries, broken bones, head injuries, severe physical trauma, heart attack and stroke; or 3) other potential risks of loss of limb, property or life.  I also understand and recognize that there are risks and hazards directly or inherently involved in travel to and from this Activity and while participating in this Activity, and I expressly assume those risks.  With full knowledge of the facts and circumstances surrounding this Activity, I voluntarily allow my teen to undertake this Activity and assume all responsibility and risk associated with his/her participation in this Activity, including all risk of injury, property damage, injury to others, and other hazards to him/her. 

Waiver: In consideration of my teen's voluntary participation in this Activity/Event and whether or not he/she travels to and from this Activity in my own personal vehicle, or whether he/she travels with another individual(s), I for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and agree to hold harmless the Franciscan Renewal Center; its trustees, officers, agents, employees, volunteers and those for whom the Franciscan Renewal Center may be held responsible, from any and all claims of liability for personal injury, accident, illness or death, and property loss arising from my participation in this Activity.  I allow my teen to willingly participate in this Activity and I assume any and all associated risks.

Assurances:  I assure officials of the Franciscan Renewal Center that I have adequate health insurance necessary to provide for and pay any medical costs that may directly or indirectly result from my teens's participation in this Activity.   I further assure that there are no health-related reasons which preclude or restrict my teen's participation.

Code of Conduct: I acknowledge that during the course of this trip, my teen is bound by the rules of behavior and conduct as outlined by the Franciscan Renewal Center and the Diocese of Phoenix.

INDEMNIFICATION:  I AGREE TO INDEMNIFY AND HOLD HARMLESS THE FRANCISCAN RENEWAL CENTER, ITS  TRUSTEES, OFFICERS, DIRECTORS, AGENTS, EMPLOYEES, VOLUNTEERS AND THOSE FOR WHOM THE FRANCISCAN RENEWAL CENTER MAY BE HELD RESPONSIBLE FROM AND AGAINST ALL CLAIMS, ACTIONS, SUITS, PROCEDURES, COSTS, EXPENSES, DAMAGES AND LIABILITIES, INCLUDING ATTORNEY’S FEES BROUGHT AS A RESULT OF MY TEEN'S INVOLVEMENT AND PARTICIPATION IN THIS ACTIVITY  INCLUDING BUT NOT LIMITED TO, ANY DAMAGE TO MY PROPERTY OR THE PROPERTY OF OTHERS AND INJURY TO MY TEEN OR TO OTHERS, INCLUDING LOSS OF LIMB OR LIFE, ARISING OUT OF PARTICIPATION IN THIS ACTIVITY.

Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the laws of the state of Arizona and that if any portion of it is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

Acknowledgement of Understanding:  I have read this waiver of liability, assumption of risk, release and indemnity agreement, fully understand its terms, and understand that I am assuming all risks associated with this Activity/Event and giving up substantial rights.  I recognize that this Release means that I am giving up the right to sue the Franciscan Renewal Center, its trustees, officers, agents, employees, volunteers, and those for whom the Franciscan Renewal Center may be held responsible, for injuries or losses my teen may incur, and I understand this Release binds my heirs, executors, administrators and assigns, as well as me.  I acknowledge that I, and as a minor, my teen, are signing this document freely and voluntarily and intend by our signatures to completely and unconditionally release the above-named parties of all liability to the greatest extent allowed by law.

Step 1: Please fill out this registration no later than January 2, 2025.  We must know our final numbers for meal planning and other pertinent retreat planning by that date.  We will not be able to refund/excuse any cancelations after this date (i.e. the $35 fee will still apply even in the event of a "no-show").

Step 2: You and your parent(s)/guardian(s) must review and sign the Media and Liability Releases.

Step 3: Once you have completed this form in all its parts, we will send you and email response to go over payment instructions.