Emergency Contact Name. Please include the name of someone who will be available during your retreat/program.*

Emergency Contact Telephone*

Your Phone*

Current Age*

Gender Pronouns*

Female

Male

Transgender or gender diverse (e.g., gender queer, gender fluid, agender).

What are your pronouns?*

Requested roommate. Type the name of the person you want to share a room with. Roommates must request each other.

First floor room needed? Do you have any mobility limitations?

Describe any serious mobility/physical limits we should be aware of (due to FND or other conditions)*

Are you planning on bringing an ADA certified service dog?

Do you have any food allergies? If yes, please tell us what allergies you have and the level of severity.*

How did you hear about FNDcourage?

PLEASE READ — IMAGE CONSENT: I grant permission to FNDcourage to take photographs and/or record digital media of me for use in promotional materials. These materials might include printed or digital products. I authorize the use of these images and recordings without compensation to me. All images and recordings shall be the property of FNDcourage.*

Liability Release All guests are required to agree to and comply with the FNDcourage Retreat Liability Release and Terms and Conditions by clicking on this checkbox on the Program Registration Page before participating in any FNDcourage Retreat program. I intend to participate in a program at FNDcourage Retreat. As a condition of my participation, I am requested to provide this Release from Liability to FNDcourage. I wish to do so as a voluntary act. I understand that the FNDcourage Retreat will be held at the YMCA of the Rockies and that the YMCA is located in a rural, mountainous setting at an elevation of 7,522 feet. There are significant, unavoidable risks of harm in such an environment, including severe personal injury or death. Residing at the YMCA and participating in the FNDcourage program also involves a risk of harm. I have had the opportunity to consider the risks I assume by residing at the YMCA and participating in an FNDcourage Retreat. Understanding these risks, I accept full responsibility for my well-being and safety at the FNDcourage Retreat. I agree to be familiar with and abide by the retreat rules and regulations. Medical Conditions: My sole responsibility is to inform the FNDcourage team of any medical condition(s) – other than FND – that may affect me while attending an FNDcourage Retreat. I understand that the nearest pharmacy and hospital are in Estes Park, about 20 min away. I am responsible for ensuring that I have enough of any medication I may be taking for the entire stay. Furthermore, I understand that some conditions can become more aggravated at high altitudes, and high altitudes may aggravate an otherwise stable medical condition. I accept full responsibility for my mental and physical well-being while in this environment. I have consulted with my healthcare provider about any concerns before registering for the FNDcourage Retreat. Emergency Medical Care: I understand that the FNDcourage is not responsible for providing emergency medical care during my visit. If the FNDcourage Retreat coordinator determines that emergency medical services are required for me, I authorize FNDcourage to arrange such care solely at my own expense. I agree to pay for all such expenses immediately upon request. The information presented by FNDcourage is NOT INTENDED or IMPLIED to be a substitute for professional medical advice, diagnosis, or treatment. All content provided by FNDcourage or this website is for general information purposes only, as we do not offer medical advice, course of treatment, diagnosis, medical opinion or treatment options. See a medical professional if you need help with depression, illness, or have any concerns whatsoever. Discuss this information with your doctor or healthcare provider to determine the best treatment plan for you. Services, products, or information obtained through FNDcourage are for information purposes only and not offered as medical or psychological advice, guidance, or treatment. Our services are neither a substitute nor replacement for professional medical or psychological care. You may or may not experience any positive results from participating in the FNDcourage retreat, services provided by Dr. Moenter, volunteers, and guests presenters. You should seek prompt medical care for any specific health issues and consult your physician before having any beauty / holistic / complementary / spiritual treatments. These statements have not been evaluated by the Food and Drug Administration. Products are not intended to diagnose, treat, cure, or prevent any disease. You should never disregard or delay seeking medical advice because of information garnered from the School of Intuitive Studies. Vehicle Damage: I understand that FNDcourage is not responsible for any damage caused to vehicles while at the FNDcourage Retreat. I release FNDcourage for any damage done to my vehicle because of rugged terrain, weather, wildlife, other vehicles, and all other sources of damage. I hereby Release, Waive, and Covenant Not to Sue and further agree to indemnify, Defend and Hold Harmless the following parties: FNDcourage, and the volunteers and/or staff, with respect to any liability, claim(s), demand(s), cause(s) of action, damage(s), loss of expense (including court costs and reasonable attorney's fees) of any kind or nature ("Liability") which may arise out of, result from, or relate to my participation in the Event, including claims for Liability caused in whole or in part by the negligence of the Released Parties. I further agree if, despite this Agreement, I, or anyone on my behalf, makes a claim for Liability against any of the Released Parties, I will indemnify, defend, and hold harmless each of the Released Parties from any such Liability which any may be incurred as the result of such claim. I hereby warrant I have read this Agreement carefully, understand its terms and conditions, and acknowledge I will be giving up substantial legal rights by signing it (including the rights of the minor, my spouse, children, parents, guardians, heirs, and next of kin, and any legal and personal representatives, executors, administrators, successors, and assigns), acknowledge that I have signed this Agreement freely and voluntarily, without any inducement, assurance or guarantee, and intend for my signature to serve as confirmation of my complete and unconditional acceptance of the terms, conditions, and provisions of this Agreement. This Agreement represents the complete understanding between the parties regarding these issues and no oral representations, statements, or inducements have been made apart from this Agreement. If any provision shall be deemed severable from this Agreement and shall not affect the validity and enforceability of any remaining provisions.*

Add a donation for FNDcourage Retreat

FNDcourage Study group facilitators ONLY

Free

Your information

Questions

Summary

Order

$0.00

Total

Payment method

Or pay another way