March 2018 Restoring a Mother's Heart Retreat Registration

Once you complete this registration please friend "Jessica Tichar Lindberg" on Facebook so you can be added to this group's private, secret page. 

Name *
Address *
Phone *
As a participant in Restoring a Mother's Heart Retreat (“Retreat”), for myself and my representatives, I assume all risks associated with participating in this event. I attest and verify that I am medically able to participate in this event. I understand the Retreat Leaders are not medical professionals. I will seek any emergency medical or medical attention if needed. I understand that I may be photographed, filmed or videotaped at the event. I hereby irrevocably grant the absolute right and permission to use my likeness and/or voice for any purpose whatsoever, including advertising for the Ethan Lindberg Foundation. I hereby certify that I have medical insurance to cover myself to cover all medical expenses that could result from illness or injury caused by participation in this event, and that said medical insurance does not contain any provision allowing said insurance company to subrogate to my rights upon payment of any medical claim to me or my child or on my behalf. I agree to indemnify and hold harmless the organizers, sponsors, agents, and representatives of the event for all damages and/or expenses incurred or claimed by me, incurred as a result of any injury or damages sustained as a result of participation in said event. I consent to participation in the event, and agree to be bound by the terms of this participant consent and agreement. *