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Nehemiah Registration Form

Nehemiah Service Retreat

  • Your spot in the Nehemiah Retreat will be confirmed after Unity has received a completed registration form, a signed liability waiver, and a photo release.
  • For questions, contact Customer Care at 816-251-3540.
  • You must be at least 18 years of age to participate.
Contact Information:
First Nehemiah Retreat?
First trip to Unity Village?
Room Preference:
Food Preference (select one):
Agreement for Nehemiah Participants
NOTE: In order for Unity to accept your registration, all boxes must be checked.
Volunteer Project Interest (please rate preference 1-3 with 1 being most interested):
Emergency Contact:
Unity Village Liability Waiver and Signature

In consideration of being permitted to voluntarily participate in any programs, facilities, or services at a Unity retreat or event, I understand and agree that Unity, its trustees, representatives, employees, or agents may not be held liable in any way for an occurrence in connection with the activity that may result in injury, illness, harm, death, or property damage to the undersigned individual.

As part of the consideration for being allowed to use Unity facilities, buildings, and grounds, as well as all appliances and fixtures in the activity, I hereby assume all risk in connection with participation in the activity. I further release Unity, its trustees, employees, agents, or representatives for any damages that may occur while participating in the activity. I further agree to save and hold harmless Unity, its trustees, employees, agents, or representatives from any claim by the undersigned, or members of the organization, their estates, heirs, or assigns arising out of or participation in any form or fashion in the activity. I also authorize Unity, its employees, or agents to render or obtain such emergency medical care or treatment as may be necessary should any injury, harm, or accident occur while participating in the activity. I also understand that Unity, its trustees, employees, agents, or representatives do not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury, illness, death, or property damage.

I further state that I am authorized to sign this agreement on behalf of myself; that I understand the terms herein are contractual and not mere recital; and that I have signed this document of my own free act and volition. I further state and acknowledge that I have been fully informed of the content of this affirmation and release by reading it before it was signed on behalf of myself.

I also authorize the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all photographs or video taken of me to be used in and/or for any lawful promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits and submissions to journalists, websites, social networking sites and other print and digital communications, without payment or any other consideration. This authorization shall continue indefinitely, unless I otherwise revoke this authorization in writing. I waive the right to inspect or approve any finished product in which my likeness appears, including written or electronic copy.

By checking the following boxes, I verify that I have read and understand the information in the Nehemiah Registration Form. I verify the truth and accuracy of the statements I have made in this application. Further, I understand that Unity will rely on the accuracy of these statements in making work assignments. Any false statement or material omission will be grounds for denying the application or dismissal from the retreat.

Agreement