Medical/Liability Release

I willingly attend & participate in the Lenten Retreat at St. Dorothy's Rest, Spring 2026. I hereby grant permission to the retreat staff and volunteer coordinators to render preventative, first aid, or/or emergency treatment that they deem necessary for my health and well-being. In the event of serious illness, the need for major surgery, or significant accidental injury. I understand that St. Dorothy's will attempt to notify the emergency contacts in the most expeditious manner possible.

I hereby:

Certify that the medical information is complete and correct, to the best of my knowledge.

Agree to assume all risk of personal injury arising from participating in this retreat.

Agree to not bring suit against St. Dorothy's Rest, and/or its staff or volunteer coordinators for any injury sustained.

Understand that if necessary in the judgment of the retreat to use outside medical, surgical, or dental treatment for my health & well being, that all such expenses shall be the responsibility of myself and/or the medical insurance company.

I agree to abide by all St. Dorothy's Rest Retreat Center rules and procedures as communicated by staff and retreat coordinators.

I agree not to bring or use firearms, ammunition, explosives, fireworks (including sparklers) while on retreat at St. Dorothy's Rest.

I agree smoking is permitted outside on paved areas only, where designated.

I agree candles or other sources of open flames are not permitted inside the buildings.

Please provide your printed name as your signature: