ECHO: Houma Registration

NOTE: We are glad you are here! Space for ECHO: Houma is limited this summer. Your acceptance to ECHO depends on a number of factors, including COVID regulations, available space, housing, and male and female ratio. We cannot guarantee everyone who desires to come will be able to be accepted. We will notify you of your status via email after submitting your application. Thank you!

**You must be 18 years of age or older AND one year out of high school or older to qualify for this retreat option.
**This retreat is initially open to young adults from the Diocese of Houma-Thibodaux. Any remaining spots will open up to other registrants one month prior to the retreat.

participant information

* Indicates required field

Name *

First

Last

Date of Birth (MM/DD/YYYY) *

Age (At The Time of Retreat) *

Sex *

Male Female

Name of Diocese *

Name of Church Parish *

Participant Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

medical information

Health Insurance Provider *

Policy Number *

Name of Primary Care Physician *

Phone Number of Primary Care Physician *

Emergency Contact Person *

Phone Number of Emergency Contact *

Relation to Participant *

Please list any environmental or medical allergies. If none, please type "none": *

medical liability waiver

I hereby authorize Dumb Ox Ministries and/or the Diocese of Houma-Thibodaux to carry out the wishes I have named (herein) in areas of emergency medical treatment and other cases of illness for myself. This authorization inclusively extends from June 25 - 29, 2021. I hereby warrant, to the best of my knowledge, I am in good health, and I assume all responsibility for myself.

In the event of an emergency, I hereby give permission to transport me to a hospital for emergency medical or surgical treatment. I ask you to advise the person(s) listed as the emergency contact to any further treatment by the hospital or doctor. I assume full financial responsibility for any medical treatment expenses I may incur. I agree to either pay for services upfront, or if Dumb Ox Ministries or the Diocese of Houma-Thibodaux pays, I agree to be billed and reimburse their expense.

PLEASE CLICK BELOW *

I Understand and Agree

Please type your full name below. This serves as your signature agreeing to the above terms. *

dietary restrictions

NOTE REGARDING DIETARY RESTRICTIONS:
We do our best to work with the retreat center to provide great food options for those with dietary restrictions. However, in some instances, the cooks are not able to provide for all needs. If this situation arises, we will contact you regarding other dining options.

Please list any food allergies or dietary restrictions we should be aware of: *

why echo?

Will this be your first ECHO? *

Yes No

If you answered no, please list any past ECHO experiences you have attended. *

ECHO is an immersive experience into the depths of our identity as men and women through the lens of St. John Paul II's Theology of the Body. We explore themes of sexuality, vocation, prayer, and relationships. We want to make sure you want to dive in!

Please briefly explain why you want to attend ECHO *

housing

Lumen Christi offers both single occupancy and double occupancy rooms with private bathrooms. However, due to COVID-19, Lumen Christi is only housing one person per room. In the event restrictions are lifted, some participants may need to share a double-occupancy room. In the event this occurs, if you are comfortable sharing a room with another participant, please list their name below. *

general liability waiver

I understand and I agree that I remain legally responsible for any personal actions taken by myself. I agree on behalf of myself or my heirs, successors, and assigns, to hold harmless and defend Dumb Ox Ministries, the Diocese of Houma-Thibodaux, Lumen Christi Retreat Center, their officers, directors, agents and staff, chaperones, or representatives associated with the event, arising from or in connection with my attending the event or in connection with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate Dumb Ox Ministries, the Diocese of Houma-Thibodaux, Lumen Christi Retreat Center, their officers, directors, staff, agents, chaperones, or representatives associated with the activity for reasonable attorney' fees and expenses arising in connection therewith.

Please click below *

I Understand and Agree

Please type your full name below. This serves as your signature agreeing to the terms above. *

covid-19 waiver

In the unprecedented times of COVID-19, Dumb Ox Ministries recognizes the additional potential risks posed by the virus and its high infection rate. As our summer activities are likely to occur during Louisiana’s multi-phase reopening, our program participants are required to read the protocols that follow, sign and return this form to Dumb Ox Ministries, and follow all protocols throughout their time to promote their safety and the safety of the other program participants, hosts, Dumb Ox staff, and those with whom they will interact at Dumb Ox events.

(1) I agree to follow all safety protocols as recommended by the CDC in regards to COVID-19. I also agree to follow those recommendations specific to Louisiana as laid out by the office of the governor, as the reopening of the state progresses. Dumb Ox Ministries may also add additional safety protocols to these lists as it sees fit. *

I understand and agree.

(2) I agree to follow all safety protocols for the duration of the event, at all times and in all places, including but not limited to, the properties of Lumen Christi Retreat Center. *

I understand and agree.

(3) I agree to hold Dumb Ox Ministries, its staff, its board of directors, its volunteers (including any hosts or host families), its program participants, and its insurers harmless from and against any and all liability, claims, demands, lawsuits, and expenses arising from personal injury, sickness, death, or property damage, including any costs related to medical treatment or injuries resulting from a COVID-19 infection. *

I understand and agree.

(4) I am aware that COVID-19 is highly contagious and I agree to assist Dumb Ox in taking these precautions for my safety and that of others. *

I understand and agree.

please type your full name below. This serves as your signature agreeing to the terms above. *

photo release & video consent

In consideration of the taking and use of the photographs or video footage of the named below, for good and valuable consideration herein acknowledged as received, I hereby grant to Dumb Ox Ministries the irrevocable and unrestricted right and permission to take, use, re-use, publish photographic pictures of me/my child or in which he /she may be included, made through any medium and in any and all media now or hereafter known for illustration, promotion, art, editorial, advertising, trade, or any other purpose whatsoever. I also consent to the use of any published matter in conjunction therewith.

I hereby waive any right that I may have to inspect or approve the finished product or products and the advertising copy or another matter that may be used in connection therewith or the use to which it may be applied.

In exchange for the benefits derived by my/my child's participation, I hereby agree that I, my heirs, distributes, guardians, legal representatives, and assigns to do release and will indemnify, hold harmless the photographer or videographer, Dumb Ox Ministries for claims for libel or violation of any right of publicity or privacy or privacy arising out of or in connection with my participation in the photography or videography project, from whatever cause, including the active or passive negligence of the photographer, videographer, or Dumb Ox Ministries.

Please click below *

I have carefully read this agreement and fully understand its contents and give my consent. I am aware that this is a release of liability and sign it of my own free will.

Please type your full name below. This serves as your signature agreeing to the above terms. *

ECHO CODE OF CONDUCT

VIOLATIONS OF ANY OF THE REGULATIONS LISTED BELOW MAY RESULT IN YOUR IMMEDIATE RETURN HOME AT YOUR EXPENSE:
1. All retreat directors and staff are to be respected at all times; instructions are to be followed.
2. Alcoholic beverages, tobacco, illegal drugs, and weapons or dangerous items of any sort are positively forbidden.
3. Room/cabin assignments may not be changed once assigned.
4. Unmarried members of the opposite sex may not visit each other’s rooms/cabins at any time.
5. Inappropriate public or private displays of affection are not allowed at any time during the retreat.
6. Anyone damaging property will be held responsible for the cost of damages. Dumb Ox Ministries, the Diocese of Houma-Thibodaux, and Lumen Christi Retreat Center are not responsible for damage expenses that an individual incurs. Theft of property is forbidden.
7. You must be on-time for all scheduled activities. Failure to follow this rule may result in loss of privileges at this retreat.
8. Obscene or abusive language, and inappropriate comments will not be tolerated.
9. Modesty in dress and behavior is required.
10. Participants must act as positive role models at all times during the retreat and respect the property and residents of Lumen Christi Retreat Center.
11. Participants must participate in all scheduled activities.
12. PARTICIPANTS ARE RESPONSIBLE FOR VALUABLES. Please do not bring valuables such as jewelry, expensive electronics, etc. Dumb Ox Ministries, the Diocese of Houma-Thibodaux, and Lumen Christi Retreat Center are not responsible for loss, damage, or theft that may result to such items.

I have read the regulations for ECHO. I understand that if I violate any of the above-mentioned rules or any others deemed necessary by the Retreat Director, I could be sent home immediately at my expense. *

Yes, I Understand

Please type your full name below. This serves as your signature agreeing to the above terms. *

cancellation policy

1. There is a non-refundable deposit of $75 required to secure your spot at ECHO. In the event of cancellation for any reason except for confirmed COVID-19 exposure, this amount cannot be refunded.
2. If cancellation occurs on or before Friday, June 11, 2021 (10 business days prior to the retreat), you will be refunded any monies paid over $75.
3. If cancellation occurs after Friday, June 11, 2021, except for cancellation due to confirmed COVID-19 exposure, we are unable to reimburse any ECHO registration fees and you are still responsible for the full registration balance.

I understand and agree to abide by the above ECHO cancellation policy. *

I Understand and Agree

Please type your full name below. This serves as your signature agreeing to the above terms. *

payment

ECHO CAMP COST:
$275.00
(Registration cost covers all food, lodging, and retreat supplies. You are only responsible for your transportation to and from retreat.)

PLEASE SELECT YOUR PREFERRED PAYMENT OPTION: *

Pay Deposit Now ($75), Remaining Balance Due June 11, 2021. Pay in Full Now

FINAL NOTE: Once you click Submit below, you will directed to the ECHO Payment and Info page. We can accept online payments as well as payments via check. If you are unable to pay immediately, please still submit your application. Just be aware that we are unable to accept your registration until at least the $75 deposit is received. Thank you!

Submit