The registration form below can be printed out and mailed or you can send it in via e-mail to gwevents@yahoo.com
Goddess Weekend Registration Form
April 9-10-11 2010
Legal Name ___________________________________Date_______________
Mailing Address _______________________________________________________
City _________________________________ State_________ Zip_____________
Phone (1st)________________________ (2nd) _____________________
Email Address _____________________________________________________
The minor attendees in my care are: (Maidens must have started menses). **If you are bringing a minor who is not your legal charge or biological family member, you will need to also bring a separate notarized document giving you permission for the weekend. It MUST be notarized!!!
Legal Name Age Relationship
Total Due: ___________($55.00/person) Amount Encl:___________
Please contact registration coordinators; gwevents@yahoo.com if you have any questions
All info must be filled in and the registration form must be signed prior to participation in this event. Return the registration from and your payment only. All other documents are for your personal records. However if you are bringing a non-related/non-legal charge, please also include a notarized permission documents as well.
Fees are non-refundable. Make checks payable to: Goddess Weekend
Mail to: 304 Meyer Rd
Wentzville MO, 63385 OR on website www.goddessweekendevents.com click on registration/tshirts page
Note, there will be a $30.00 fee for any bad checks written and you will be expected to pay by cash, cashiers check or money order at this and future events. To ensure availability, mail registration forms with payment before March 28, 2010. Email by April 7, 2010
By signing/emailing this waiver, I agree that I have read the entire Registration Brochure, Waiver, Release, and Indemnity, Minor’s Consent to Participate and Hold Harmless Agreement thoroughly, that I understand the rules of this Goddess Weekend 2010 Retreat and agree to abide by them, and that I am at least 18 years of age.
Legal Name
Signature Date
I am a nursing mother with baby, and/or needing special arrangements. (Limited space available) Yes No
Due to limited sleep and activity preparations Crazy Crones Night Owl Cabin will be designated as minor free cabins. Sign designation will be posted on this cabin. As with all cabins, first come, first serve.
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Goddess Weekend Information
Are you a member of Goddesses of the Oak list?
Goddess of the Oak is not affiliated with Goddess Weekend Events, however it is a list where participants can communicate and receive announcements about upcoming weekends.
If you would like to be subbed to this group for email announcements please contact gwevents@yahoo.com so that we can get you added to the Goddess of the Oak List.
NO PETS are allowed in the Babler Outdoor Education group camp. Please leave pets at home. Only service animals, Such as sight dogs, will be permitted.
PHOTO RESTRICTIONS. GW recognizes that many of our attendees are not publicly open regarding spiritual practices. In honoring of this privacy issue, we ask that you not take any photographs of work shops, rituals, and people without getting consent of those individuals first. Those who ignore this request may be asked to leave the event.
DISCREETLY WET. GW 2010 must follow the rules of Babler State Park regarding alcohol consumption. Please do not openly display alcoholic beverage containers or drink to excess. Those who violate this expectation may be asked to leave the event.
NO FIREARMS, FIREWORKS or WEAPONS. Blades used for athames are permitted.
Per State law expectations in a public camp, GW 2010 is NOT a clothing optional event. Please dress festively, but modestly. GW campers are expected to follow all state and local laws. Please do not leave minors unattended or participate in activities prohibited by law. Parking will be allowed in Babler State Park parking lot and on camp gravel road (as directed). Extra parking areas will be designated by Park Rangers as needed the day of event. Please park where designated only.
Fees: This event’s fees include pot luck Friday dinner, 3 meals on Saturday, and Breakfast on Sunday.
Send in money and forms by February 28, 2010 with a fee of $50.00 per GW attendee. Please make checks or money orders payable to: Goddess Weekend with GW 2010 in memo line. Cash is accepted. Credit cards are not. Late registration begins March 15 and ends March 31 with a fee of $55 per GW attendee. Registration after April 1 must be made via email and the fee will be $60. Registration ends April 7. ALL REGISTRATION MUST BE IN NO LATER THAN April 7. Reservations can be held with a $25 deposit per attendee with the balance due at check in!!! Other payment arrangement can be made by contacting gwevents@yahoo.com and will be determined on a case by case basis. Please provide your legal name, phone number and the arrangements you would like to propose and we will contact you to discuss. We also have Day Passes available for Saturday, April 10, 2010 for a fee of $25.00 per attendee. Pre-registration is required for day pass. Day pass attendees can arrive anytime after 7:00 AM, and must leave no later than 9:45 PM that day.
LODGING:
All lodging is in cabin style building with single beds available. These beds are able to be moved together for couples to share space. Please bring your own bedding and bathing linens. Each cabin is equipped with bathroom facilities. There is no cooking allowed in the cabins. Dishes for meals are provided by the camp, but may not be taken out of the dining hall. If you find any throughout this event, outside of the dining facility, please bring them back in. Event hosts are financially charged for any lost dishes and utensils, so please keep them in the dining hall. Site is limited to 150, so it is important to register early. Those seeking extra privacy or accessibility can opt to stay in the Quiet/Special Needs Cabin. Please indicate this on your registration papers.
MEALS & INFORMATION:
Entrée will be provided Friday night; please bring side dish and/or dessert to share (Please no Chips). Three meals on Saturday and Sunday breakfast will be provided. For Vegetarian and Specialty diet needs and/or registration information, please contact; gwevents@yahoo.com to specify needs.
Vending is available at this event. Vending will be located in the Rec Hall. Please provide your own table and vending supplies. No tents please, this is indoors and room is locked after 1:00 AM. Space is limited, so please call to insure your spot. Security is not provided at this event and Sacred Word Coven, its members, and Babler State Park is not liable for any missing, broken, or stolen merchandise or personal belongings. A Lost and Found Box will be placed in Main Building for any items found throughout this event. For more information regarding vending please contact: gwevents@yahoo.com
For workshop information or to schedule your workshop please contact gwevents@yahoo.com.
Time slots for workshops will fill quickly, so please contact early.
Waiver, Release, and Indemnity
Do NOT sign the registration until you have read the entire document. By signing the registration, you acknowledge that you are aware of and AGREE to all guidelines for this gathering.
I am aware that there are risks involved in my participation in Goddess Weekend events, including the natural and rugged nature of the site and I hereby agree to assume such risks. I take full responsibility for my safety, well-being and actions, as well as the safety, well being and actions of any minors in my charge.
I agree not to sue and/or press any actions or claims against the landowners, or the Goddess Weekend organizers, agents, and volunteers FOR ANY INJURY occurring to me or to anyone through whom I may claim at said event RESULTING FROM ACCIDENT, NEGLIGENCE, and/or PARTICIPATION ON ANY INDIVIDUAL ACTIVITY.
I also understand that the land and the retreat are subject to all state, local, and federal laws, and that neither the Dept. of Natural Resources or Goddess Weekend condones or encourages the violation of these laws, and that neither Dept. of Natural Resources or Goddess Weekend nor their agents, is to be held responsible in any way should individuals or groups of persons act on their own behalf in violation of any state, local, or federal laws.
By signing the registration, I agree to the following guidelines:
I will…
*not bring or indulge in illegal substances
*per State Park requirements: consume alcohol discreetly, in moderation and keep it within the campsite
*per State Park requirements: keep any vending within the campsite
*not bring firearms, fireworks, pets, or ineligible/unregistered guests.
*place my automobile in the appropriate parking area, and not park on any roads, or on the grass and take personal responsibility for any consequences should I not move my vehicle to the assigned parking area
*take full responsibility for the health, care, welfare and behavior of any minors in my care
*not allow any minors in my care to be unattended at any body of water
*obey all park rules
This agreement is binding upon my heirs, executors and assigns. This waiver covers the period of April 9, 2010 through April 11, 2010 inclusive. I understand that if I choose not to respect the guidelines of this gathering I will be asked to leave and I agree to comply.
Minor’s Consent to Participate and Hold Harmless Agreement
Hereafter referred to as “the minor” does hereby state that the minor wishes to participate in the activities sponsored by the organization known as Goddess Weekend, an eclectic spiritual retreat group.
Goddess Weekend may have rules that restrict the ability of a minor to participate in specific activities. Goddess Weekend makes no claims or representations to the safety or conditions of the land, structures or surroundings of the retreat location.
The minor’s parent(s) or guardian(s) understand that all activities are voluntary and no one is required to participate. It is understood that some activities are potentially dangerous or harmful to the minor’s person or property, and that by participating, the minor’s parent(s) or guardian(s) voluntarily assumes risk of injury to the minor or damage to the minor’s property.
It is understood that Goddess Weekend DOES NOT provide any insurance coverage for the minor’s person or property; and the minor’s parent(s) or guardian(s) acknowledge they are responsible for the safety and the minor’s own health care needs, and for the protection of the minor’s property.
In exchange for allowing the minor to participate in the weekend retreat and activities, the minor by and through the undersigned, agrees to release from liability, agrees to indemnify, and holds harmless the Goddess Weekend organizers and the Missouri State Parks, for any injury to the minor or damage to the minor’s property.
This release shall be binding upon the minor, the parent(s) or guardian(s), and successors in interest, and/or any persons suing on the minor’s behalf.
The minor’s parent(s) or guardian(s) understand this document is complete unto itself and any oral promises or representations made to them concerning this document and/or its terms are not binding on the coordinators of Goddess Weekend.
Parent or Legal Guardian Must Sign Below:
This consent form only needs to be signed if the minor is NOT coming with her legal parent/guardian. This form must be notarized.
I, the undersigned, state that I am the parent or legal guardian of the minor whose name appears above. I understand that the above terms and conditions apply to said minor and to my self. I further understand that said minor cannot participate under ANY circumstances in any activities deemed illegal for persons under 18. The minor will not be able to participate in any Goddess Weekend activities without entering into this agreement. This document is binding on my self, the said minor and any person suing on behalf of said minor.
Minors Name (print) _____________________________________________________
Birth date of minor: _________________________ Home state of minor: ___________
Parent or Guardian Legal Name (print): ______________________________________
The Following Medical Authorization form is required for each Minor
I, _________________________________________, parent or legal guardian of
_______________________________________ do hereby authorize on one or more of
___________________________, _______________________ or ________________
as agents for myself in my absence or incapacitation to consent to any X-Ray examination and anesthetic, medical or surgical diagnosis or treatment and medical care which is deemed advisable by and is to be rendered under the general or special supervision of any physician or surgeon licensed under the provisions of the Medical Practice Act on the medical staff of any hospital whether or not such diagnosis or treatment is rendered at the office of said physician or at said hospital.
It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of the aforesaid agents to give specific consent to any and all such diagnosis, treatment or hospital care which aforementioned physician in the exercise of his or her best judgment may deem advisable.
I hereby authorize any hospital which has provided treatment to the above named minor to surrender physical custody of such minor to the above named agents upon the completion of treatment.
These authorizations shall remain effective during Goddess Weekend 2010 (April 9 to 11 2010), unless sooner revoked in writing delivered to said agents.
Date: _________________ Legal Signature: ___________________________________
Insurance Company: ______________________________________________________
Insurance group number or code: ____________________________________________
Parent Signature: _____________________________ Notary Stamp:
Date: _________________
Notary Signature: _____________________________
Date: _______________________________________
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