JETAANY Summer Retreat Registration 2019
When: Saturday, August 10 - Sunday, August 11, 2019
Where: Pocono Environmental Education Center, 538 Emery Rd, Dingmans Ferry, PA 18328
Regular registration closes Sunday, August 4


Email address *
First Name *
Your answer
Last Name *
Your answer
Phone Number *
Your answer
Gender *
Age *
Dietary Restrictions (check all that apply) *
Relationship to JETAANY *
If you are a guest/friend of JET, please list the name of the JET you know.
Your answer
What days will you attend? *
What activities are you interested in (check all that apply)? *
I would like JETAANY to organize transportation *
Approximate Cost: $15-$25 each way, $30-$50 total. If there is enough interest, we will follow up with payment information.
Roommate Preferences
Please let us know your roommate preferences. Each cabin accommodates 2-6 people in bunk beds. All rooms share bathroom facilities (either located in the cabin or nearby). We will try to accommodate your preferences as best as we can. You can choose up to 3 roommates (leave blank if you aren't staying overnight):

Note: Please bring your own linens (sheets/blankets/towels/pillows). The cabins do not have air conditioning.

Name - Roommate 1
Your answer
Name - Roommate 2
Your answer
Name - Roommate 3
Your answer
Please check all that applies to you *
Comments on Rooming
Your answer
Emergency Contact
In case of accident or due to serious illness or injury I hereby authorize JETAANY and its representatives to contact the person listed below. The number provided should be a mobile number where the contact can be reached at all times.
Emergency Contact Name *
Your answer
Emergency Contact Relationship *
Your answer
Emergency Contact Number *
Your answer
Waiver and Additional Information
WAIVER, RELEASE AND ASSUMPTION OF RISK: I hereby waive and release the JET Alumni Association of New York (JETAANY) and its representatives from any actions, claims, liabilities, and damages arising from or relating to the 2018 JETAANY Summer Retreat, and all associated activities, including, without limitation, any damages for personal injury, illness, death, or property loss that I may sustain or experience in connection with this program. I hereby assume, knowingly and voluntarily, all risks of my participation. To the fullest extent allowable under law, this waiver, release, and assumption of risks will apply whether or not JETAANY and its representatives is wholly or partially negligent or otherwise at fault.

In case of accident or due to serious illness or injury I hereby authorize JETAANY and its representatives to contact the names I have previously provided in case of emergency.

On behalf of myself, and my heirs, assigns, and legal representatives, I have read, understand and entered into this Form. I consent to the application of the laws of New York to govern, interpret, and enforce this Form, including all rights and obligations arising from or related to this document, without regard to conflict of law principles.

Please read and acknowledge the statement *
If you have any other comments, suggestions, or questions, please let us know:
Your answer
Your registration is NOT COMPLETE UNTIL YOU HAVE PAID for the trip. Please do so using Cognito Forms at or go to If you requested transportation, we will follow up with payment information at a later date. If you are paying for more than one person, please make a note in the comments above.
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