Register For THARSEO 2025

Name of Registrant *

This would be the name of the person registering for retreat, also for youth.

First Name

Last Name

Address *

This refers to your address in MA.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Country

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Check all that apply regarding rides to retreat. *

I do not need a ride and will go myself

I will need a ride

I am willing to give rides

Emergency Contact Name *

For youth: Please list your guardian.

First Name

Last Name

Phone of Emergency Contact *

Country

(###)

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Consent Form *

For Youth: "I, the undersigned, have legal custody of the student named, a minor, and have given our consent for his/her attending North Boston KUMC's Winter Retreat. I understand that there are inherent risks involved in any ministry or athletic event, and I hereby release NBKUMC, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my child's involvement. In the event that he/she is injured and requires the attention of a doctor, I consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physical and/or hospital personnel designated by NBKUMC, I agree to hold such persons free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider." For Adults: "I, the undersigned, am choosing to attend North Boston KUMC's Winter Retreat. I understand that there are inherent risks involved in any ministry or athletic event, and I hereby release NBKUMC, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my involvement. In the event that I is injured and requires the attention of a doctor, I consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physical and/or hospital personnel designated by NBKUMC, I agree to hold such persons free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider."

I consent to the above.

I do not consent to the above.