Alumni ESCAPE
              Registration

To secure a place at Alumni ESCAPE 2011, your registration and payment must be received by April 1, 2011.


Space is limited, so register early!

Registration and Waiver


There are TWO steps to register for Alumni ESCAPE:  (1) fill in the form below and accept the waiver below and (2) go to the payment page and pay the registration fee.


The registration fee for this year is $105 which includes program fees, food, snacks, and overnight lodging.  You may pay through PayPal for an additional fee of $3.00 after submitting your registrtion.  If you do not wish to pay by PayPal, please contact us at alumniescape@gmail.com

Name

Name you prefer to be called

Address: street, city, zip

Email

Home phone

Office/Cell

Emergency Contact: name and phone

Do you have health insurance? *You must to attend

Roomate Preference (we will try to accomodate all requests)

Special dietary needs, allergies or other medical conditions

Do you have a car?

If yes, are you willing to transport others from the DC area to Shepherd's Spring?

If no, would you like to participate in a carpool from the DC area to Shepherd's Spring

If you will be arriving from out of town, what is your travel itinerary (method, time)

Georgetown school and year (or affiliation, if not a GU grad)

Did you attend ESCAPE at GU?

If yes, what year?

Were you a Team Leader?

If yes, what team?

Did you attend Alumni ESCAPE?

If yes, what year?


I fully understand that my participation in the above program is purely voluntary and that the Alumni ESCAPE Planning Committee neither expressly nor impliedly require my participation. I further understand that the Alumni ESCAPE Planning Committee is not an incorporated association or organization; rather, it is a collection of individual volunteers who will lead a voluntary retreat program for individuals. I fully understand that Alumni ESCAPE is not an official program of the Office of Campus Ministry at Georgetown University and is in no way sponsored by Georgetown University, nor any of its affiliates. In consideration of my participation in this program, I, on behalf of myself, my heirs, representatives, executors, administrators and assigns do hereby agree to release and hold harmless the Alumni ESCAPE Planning Committee with respect to any and all claims, damages, judgment, actions and causes of action, arising out of my acts of omissions, and from any cause of action, claims or demands of any nature whatsoever, which I, my heirs, representatives, executors, administrators and assigns now have, or may have in the future against all parties on account of my personal injury, property damage, death or accident of any kind arising out of or in any way related to my participation in the program, including transportation to and from the program, whether that participation is supervised or unsupervised, however the injury is caused. I also verify that I am enrolled in a medical insurance program, and I acknowledge and agree that the Alumni ESCAPE Planning Committee is not liable for any medical or related expenses, including those that may not be covered by the medical insurance program. Further, I agree to be billed for an pay in a timely fashion any damages to any of the facilities, furniture or equipment located at or owned by Shepherd’s Spring, lost property, and unnecessary service costs arising out of my conduct, acts, or omissions.

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