Pastoral Reflections Institute

Fall 2019 Pilgrimage Release Form


In consideration for receiving permission to participate in the religious retreat approximately located in the town of Subbiano, the province of Arezzo, and the country of Italy from November 3, 2018 through November 10, 2018 (hereinafter referred to as the “Retreat”) that will be conducted by Pastoral Reflections Institute, a Texas nonprofit corporation and an organization described in Section 501(c)(3) of the Internal Revenue Code of 1986, as amended (the “Institute”), I, the undersigned, hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the Institute’s staff, volunteers, officers, agents, servants, employees or members of its Board of Directors (hereinafter referred to as “RELEASEES”) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me or any of the property belonging to me, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES, or otherwise, while at the Retreat or participating in the programs or activities conducted at the Retreat, or while in, on or upon the premises where the Retreat or its activities are being conducted.

I hereby give my informed consent to attend and participate in the Retreat, as well as its related programs and activities, and, except as otherwise set forth by me in written advance notice to the Institute, to sponsored trips that may occur during the Retreat. Although most of the activities that will occur during the Retreat involve religious teaching and reflection, I am aware of the variety of other activities that the Institute offers (sports, recreation, cooking, and day trips) and understand that activities of these types involve some risk. The Institute will take all reasonable precautions with respect to its programs, activities and trips, but to the extent that such programs, activities and trips involve any risk of property damage or personal injury or harm to myself, I EXPRESSLY ASSUME SUCH RISK FOR MYSELF, MY HEIRS, ASSIGNS, AND REPRESENTATIVES, AND HEREBY RELEASE TO THE FULLEST EXTENT PERMITTED BY LAW AND AGREE TO INDEMNIFY AND HOLD HARMLESS THE INSTITUTE, ITS AFFILIATES, AGENTS AND CONTRACTORS, AND ITS AND THEIR DIRECTORS, OFFICERS, MEMBERS, EMPLOYEES, ASSISTANTS, STAFF, VOLUNTEERS, AND HELPERS, FROM ANY AND ALL LIABILITY, ACTIONS, CLAIMS, OR DEMANDS THAT RELATE TO OR ARISE FROM MY PARTICIPATION, OR FAILURE TO PARTICIPATE, IN THE RETREAT, AND ITS RELATED PROGRAMS, ACTIVITIES AND TRIPS.


Participant Signature: _____________________________ Date: _______________________

Printed Name: ___________________________________