* Denotes required field.
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
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.
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