2026 Breathe Easy Retreat Information, Waiver & Release Form

Breathe Easy Retreat Information, Waiver & Release Form
Participant Name

First NameLast Name
DOB

MonthDayYear
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Do you have any dietary restrictions?
Please describe any other restrictions or accomodations you will need during the retreat:
How will you be arriving to the retreat?
If you are flying in to SeaTac airport, what time does your flight arrive on Thursday 4/16?
What time does your flight leave SeaTac on Sunday 4/19?
All rooms are shared (beds are not shared). You will be assigned to a roommate. Do you have someone specific you would like to share a room with? If you don't know anyone or have no preference, type N/A:
What size shirt/sweatshirt do you wear?
What is your favorite candy or snack?
Loved Ones

We would love to contact a loved one in your family for one of our activities. This can be a partner, spouse, parent, grandparent, family member or friend. We would like for this to be someone that is involved in your life and your CF child's life. This is optional, but we promise it will be worth it!
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to attendee
Emergency Contact
Please provide at least one emergency contact we may use:

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to attendee
Waiver and Release
Photography & Video Release

I hereby grant Vivian Lee Foundation (“the Organization”) permission to use my photograph, video, or likeness in any and all of its publications, marketing materials, social media, and promotional efforts, without payment or any other consideration.

I understand and agree that:
- The images may be used in print, digital, and online formats for promotional and educational purposes.
- The Organization owns all rights to the images and may edit, alter, or enhance them as needed.
- I waive the right to inspect or approve any final product in which my likeness appears.
- I release the Organization, its staff, volunteers, and affiliates from any liability related to the use of my image.
Waiver

I am aware of the dangers of attending the Breathe Easy Restorative Retreat on April 16th, 2026 through April 19th, 2026 in Bainbridge Island, Washington. I will not hold Vivian Lee Foundation and IslandWood, its officers, agents, or employees liable or pursue legal action against them. This waiver absolves Vivian Lee Foundation and IslandWood of any duty for injuries sustained on the premises before to, during, or after the activity.

By signing this agreement, I agree to hold the company completely harmless, including financial responsibility for any injuries sustained, regardless of the cause or circumstances.

I will do all in my power to obey corporate staff and all safety requirements, and I will seek clarification if necessary.
Participant Signature
Today's Date

MonthDayYear
Date
Should be Empty:

Breathe Easy Retreat Information, Waiver & Release Form

Loved Ones

Emergency Contact

Waiver and Release