Mental & Health Awareness "Rejuvenate Woman" Empowerment Retreat
Event Timing: June 7th-9th, 2024
Event Address:  17801 Lake Perris Dr, Perris, Ca. 92571 Spots 226-236
Contact us at (951) 712-5031 or Melaninyouthfoundation
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"Rejuvenate Woman" Empowerment Retreat
The Melanin Youth Foundation
19510 Van Buren Blvd. Ste F3 PMB 152
Riverside, Ca 92508
Name *
Email *
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Age? *
Size *
What days will you attend? *
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What days will you be camping overnight? *
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How many people will be attending? *
Pleas list name, age and size if you are also registering for a minor.  Enter N/A if not applicable *
Do you have a camping set up?
Tent, air mattress, sleeping bag, camping lamp
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What Item's don't you have?  Enter N/A if not applicable *
What are your area's of interest? *
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Dietary restrictions *
DISCLOSURE
I understand that this is a complimentary event for women and  adolescent girls.  There are a total of 50 camping spots available and that only the first 50 registrants will be guaranteed a full camping setup (includes: Tent, air mattress, sheets, sleeping bag, Towel, washcloth and camping light) includes 2 people per tent.  I hereby knowingly and voluntarily assume any and all risks and do agree and acknowledge that my participation in the Events and any of the events or programs associated with the Event is of MY OWN FREE WILL AND COMPLETELY VOLUNTARY, regardless of anything stated or implied.   I am fully responsible for any and all decisions I make in conjunction with the Event and I alone will determine which activities I will participate in. I further understand that I DO NOT HAVE TO PARTICIPATE IN ANY ACTIVITY AND I MAY WITHDRAW MYSELF FROM PARTICIPATION AT ANY TIME. I agree I will use my own free will and discretion, considering my physical and mental health, when deciding if it is appropriate for me to participate in any activity.    I do hereby acknowledge that the activities at the Event may pose known and unanticipated substantial risks of physical injury, psychological or mental injury and/or death, disease or illness and/or damage to or loss of personal property.   I indicate by my signature below that I have had sufficient opportunity to read this entire release and waiver document and acknowledge that I have understood it, and agree to be bound by its terms. No representations, statements or inducements, oral or written, apart from the foregoing written statement, have been made.  

Photography:
I, the undersigned, of legal age, hereby grant, irrevocably and perpetually to The Melanin Youth Foundation., (MYF) and their subsidiaries, affiliates, successors and assigns thereof, the following:
The right to photograph, video and record my name, voice, appearance, likeness, and/or written testimony along with any material furnished by me, in whole or in part, in any program provided by MYF, or any affiliate, subsidiary or assign of MYF.
The right to publish, exhibit and distribute the use of my name, voice, appearance, testimonial and/or likeness along with any material furnished by me, in whole or in part, worldwide, for any commercial purpose, including but not limited to the advertising or solicitation of business, by any means of mass and/or electronic media, including but not limited to print, radio, television and promotional materials, events and/or marketing plans.

I hereby release and agree to indemnify and hold harmless MYF and their subsidiaries, affiliates, successors, assigns, officers, directors, agents, owners, employees, thereof, from any and all claims, actions, causes of action, damages, expenses, court costs, attorney fees, liability damage or judgment brought forth as a result of my participation or testimonial materials furnished by me.

I hereby acknowledge that I have not been paid or otherwise compensated, nor will I be compensated, for my participation to record and publish my name, voice appearance, likeness, and/or written testimony, along with any material furnished by me, in whole or in part. I further certify that all material, whether verbal, written or exhibited by me has not been scripted and represents my individual opinions and beliefs, and are true and correct to the best of my knowledge. I understand that by checking yes and clicking submit acts as a legal signature and, I agree the these terms.
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