Women’s Picnic

Date: Saturday, May 13th
Time: 11:30 a.m. to 2 p.m.
Location: Tom Sawyer Park
Address: 2201 Lakeland Rd, Louisville, KY 40241

Fresh air and a chat with friends! What better way to spend a Saturday than with a picnic in the sunshine? Lunch will be provided. This event is free to mothers of children with disabilities and is presented in partnership by Barren Heights and Critically Loved. Complete the form below to join us for this fun event!

Name*
First Last
Phone Number*

Format: (xxx) xxx-xxxx
Email*
Food Restrictions (if any)*
Do you have a child with a physical or developmental disability?*
- Yes
- No
Please list your child's specific diagnosis.*
Want to receive emails about future retreats, community events, and Barren Heights updates?
- Yes!
All application information is kept confidential. Application information may be shared with event volunteers to better equip them to serve your family.

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 Barren Heights and Critically Loved for training, promotion, and fundraising.
- I release Barren Heights and Critically Loved, their directors, and volunteers, and the Community & Retreat 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, 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 understand that in order for everyone to experience a sense of calm, peaceful relaxation, this event is an alcohol, drug, and smoke-free environment. Use of cell phones is discouraged except when necessary.
- I hereby release and agree to Barren Heights’ and Critically Loved's hold harmless form, 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 and Critically Loved together with all owners, partners, volunteers, and employees.
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Women’s Picnic

Women’s Picnic

Hold Harmless Agreement

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