Choices of the Heart | 2023 - Daughters of Charity

For more information, contact a vocation director.

This event is by invitation only.

Full Name(Required)

First Last

Age(Required)

Email Address(Required)

Phone Number(Required)

COVID Vaccination Status(Required)

Received Vaccine

Received Booster in the Last 6 Months

Recently had COVID

Not Vaccinated

Please list any dietary needs or food allergies.

Emergency Contact Information

This information will be used for emergency issues during this event only.

Emergency Contact Name(Required)

First Last

Emergency Contact Relationship(Required)

Emergency Contact Phone Number(Required)

Travel Plans

If you plan to fly in or take the bus to and/or from St. Louis, we can provide transportation. If you are unsure of your exact travel plans, please provide as much information as you can now and update the information with us later.

I will be arriving via...

Airplane

Car

I plan to arrive...

Please include date and time.

Arriving Airline & Flight Number

I plan to depart...

Please include date and time.

Departing Airline & Flight Number

I need transportation to _____________.

Consent(Required)

I agree to the below Waiver and Release of Liability

I would like to participate in Choices of the Heart ("Choices"). In consideration of being allowed to participate in Choices, I have freely and voluntarily executed this Waiver, Release of Liability and Photo Release and Consent Form (“Waiver”). By signing this Waiver: (i) I understand that my participation in Choices may include certain physical activity that could result in injury, illness, death and/or property damage and I hereby expressly assume the risk of such harm; and (ii) I hereby expressly agree to forever release, discharge and hold the Daughters of Charity and all of their agents, employees, successors and assigns (DC) harmless from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from my participation in the Choices, including but not limited to injury, illness, death and/or property damage.

Media Consent

I agree to the below Media Consent

I hereby grant DC (as defined in the Waiver above) the right to use, copyright and/or publish in any medium, including but not limited to print media, social media and other online websites, all photographs or videos made of me during my participation in Choices for advertising or promotion of DC regardless of whether such photographs or videos are retouched or otherwise changed in character or form. I understand that I shall have no right to any compensation or to inspect or approve such photographs or videos prior to publication and all such photographs and videos shall remain the property of DC.

Choices of the Heart | 2023

Emergency Contact Information

Travel Plans

Sign up for our email list!

Search

Connect