Women’s Hike & Picnic

Date: May 15th, 2021
Time: 11:00 AM – 2:00 PM
Location: Tom Sawyer Park
Address: 3000 Freys Hill Rd, Louisville, KY 40241

As a way to celebrate our wonderful moms for Mothers Day, we are hosting another Women’s Hike and Picnic. We hope that this opportunity to get outdoors and fellowship with other mommas is just what you need. After we provide lunch, we will split into two groups, so you can choose to go on the short stroll, or the longer hike- it’s up to you! We hope to see you all there. 🙂

Women's Hike

First and Last Name*
Phone Number*

Format: (xxx) xxx-xxxx
Email*
Which organizations are you affiliated with?*
Food Restrictions (if any)*
Do you have a child with a physical or developmental disability?*
- Yes
- No
Please list your child's specific diagnosis.*
All application information is kept confidential. Application information may be shared with retreat volunteers so they are better equipped to serve your family. This information will not be distributed or used for marketing purposes.

Hold Harmless Agreement

By checking the boxes below you are agreeing on behalf of your family to an electronic signature.
Please check if you agree with the following statements:*
- Select All
- I give my consent that the information given at registration may be communicated with leaders and volunteers for the purpose of being equipped to provide the best care and assistance possible to my family.
- I give my consent that photographs, interviews and audio/visual recordings during the course of the event may be used by the Mom's Night Out sponsoring organizations for training, promotion, and fundraising.
- I understand that in order for everyone to experience a sense of calm, peaceful relaxation, this event is an alcohol, drug, and smoke-free environment.
- I release Barren Heights, its directors, and volunteers, and the Community Center facility from all actions, damages, or personal injuries which may occur to me or a member of my family. I understand that in the event of a minor injury, I, or a member of my family may receive first aid treatment. I will be informed as soon as possible of any injury or condition of one of my family members and will be responsible thereafter for their care. In the event of an emergency, injury, or illness (including COVID-19), emergency medical services and I will decide the best course of action. If the leaders are unable to reach me, I authorize them to take whatever action is necessary for the safety and health of my family members.
- I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.
- I further acknowledge that Barren Heights has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.
- I further acknowledge that Barren Heights cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others.
- I voluntarily seek services provided by Barren Heights and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19
- I hereby release and agree to hold Barren Heights harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss. I understand that this release discharges Barren Heights from any liability or claim that I, my heirs, or any personal representatives may have against them with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to any services rendered. This liability waiver and release extends to Barren Heights, together with all owners, partners, volunteers and employees.
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Women’s Hike & Picnic

Women’s Hike & Picnic

Women's Hike

Hold Harmless Agreement

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