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Inbound Retreats Registration

Participant Application

* Denotes required field.

  • Please note that this is the e-mail address that we will use to notify you of your retreat placement in late July.

  • Please rank the retreats in order of interest.
    When deciding on a retreat, please consider the activities involved with each retreat and your confidence in being able to fully participate in those activities. For more detailed information about the retreats available this year, please click here.

  • Participant Release

    I acknowledge that my participation in the Juniata College Inbound program includes known and unanticipated risks, which could result in physical or emotional injury, and I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity.

    I understand that all College policies apply during my participation and I accept responsibility for following these policies. I also understand that I am participating in this program at my own risk, and that Juniata College is not responsible for the consequences of my actions or behavior. I will consult with the Trip Leader if any problems arise during my activity.

    I hereby represent that I am in good health, and I shall adequately inform Juniata College personnel of any special instructions or medical needs regarding myself prior to participation. I certify that I have adequate medical insurance to cover any injury or damage that I may suffer while participating, or else I agree to bear the costs of such injury or damage myself.

    I authorize Juniata College personnel to call for medical care to transport me to a medical facility or hospital if, in the opinion of such personnel, that I need medical attention. I further authorize appropriate personnel to render such medical treatment as is necessary for the health of myself, in their professional opinion. I agree that once I am in the care of medical personnel or a medical facility, Juniata College shall have no further responsibility for me, and I agree to pay all costs associated with such medical care and transportation.

    By my agreement to participate in this program I confirm that I understand the risks with regard to traveling and participating in this activity and I shall not hold Juniata College, its agents, employees or representatives liable for any damages or losses arising from my participation in the program. Further I will indemnify and hold Juniata College, its agents, employees, or representatives harmless from any damages or losses arising from my participation in the program.

    I represent that I am at least eighteen years of age or, if not, that I have secured the permission of my parent or guardian as well as my own.

    I agree to the terms above.
    I do not agree to the terms above.

    Photography/Video Recording/Audio Recording Subject Release
    Yes, I hereby authorize Juniata College, its employees, agents, and/or assignees to photograph, audio record, video record, obtain, reproduce and/or use my likeness for marketing, educational or other such reasonable use. I knowingly and purposefully waive my specific right to privacy, publicity and all other rights pertaining to the use of my photograph, likeness, voice and/or image.
    No, I do not give permission to be photographed, audio recorded and/or video recorded.

      More about you:

      Please note that every first-year student who registers by the Friday, July 1, 2016 deadline will be given the opportunity to participate in Inbound regardless of skills/abilities. Any information you share during this application is confidential, and its sole purpose is to assist the Inbound team in placing you in a retreat that will best match with your skills/abilities and accommodate special needs as we are able during the program.

    • Yes   No
    • Yes   No

    • For more detailed information about the retreats available this year, please click here. *