Name *

First Name

Last Name

Emergency contact person *

First Name

Last Name

CONDITIONS OF PARTICIPATION IN THE RETREAT: *

I have read the list of what to bring page and agree to pack accordingly. Food, single accommodation, towels, linen and bedding are provided. The retreat offers daily prayer in the Christian tradition, based on prayers of the Anglican denomination and readings from the NRSV translation of the Bible. Participants are invited to attend, and expected to respect the rights of others in their choices. Participants whose behaviour or conduct jeopardises the welfare or fulfilment of the retreat objectives may be required to withdraw. I agree that I am aware that photographs taken of participants by the retreat leaders or other members of the retreat, and materials contained in the Koora Retreat visitors’ book and in the official retreat diary may be used by Koora Retreat Centre at its discretion unless otherwise advised in writing by me. Neither Koora Retreat nor its leaders assumes responsibility either financial or otherwise for illness or injury that might occur during a retreat. Emergency transport, medical or hospitalisation costs resulting from illness or accident during the retreat are the responsibility of the person receiving such care. In cases where the retreat leader in consultation with medical authorities considers it necessary, a participant will be sent home or hospitalised. I am aware that while participating in this retreat, certain exposures to risk may occur. These exposures include but are not limited to accident and/or sickness without readily available medical facilities, the forces of nature, camp fire smoke, water, local flora and fauna, travel on the ground, on rocky surface, through vegetation, in vehicles and other. In consideration of the right to participate in this retreat program I do hereby assume all of the risks involved and agree to indemnify and hold Koora Retreat Centre Inc and its associates, officers and volunteers harmless for any and all liability that may arise in connection with my participation in the activities which are part of the retreat program. I agree that these conditions shall be governed in all respects and interpreted in accordance with the Australian laws. Koora Retreat reserves the right to cancel or make changes to retreat programs when conditions such as forces of nature or train schedules require and/or cancel any retreat with an insufficient number of participants or for any other reason considered detrimental to the success of the retreat. In such circumstances, you contribution will be refunded in full. However, Koora Retreat is not responsible for non-refundable tickets or similar penalties that may be incurred due to such cancellation.

I have read and fully understand and agree to the conditions of participation detailed above and contained in this Koora Retreat Centre Application Form