Pilgrim Application

  • Section 1: Participant's Information

  • Sponsor's Information

  • Section 2: Participant's Special Needs & Medical Information

    The purpose of sections 2 and 3 are to provide medical information in the unlikely event that medical treatment is necessary during an Emmaus Walk. All information will remain confidential.
  • Section 3: Authorization for Medical Treatment

    In the unlikely event that medical intervention is necessary for the Participant, every attempt will be made to contact the individual designated as “Emergency Contact Person.” Only if that person cannot be reached in an emergency during the Emmaus Walk for which permission has been granted for the Participant to participate, I hereby give my permission to the Emmaus Leadership Team to hospitalize at preferred hospital (or any hospital reasonably accessible),secure medical treatment and order any injection, anesthesia or surgery for myself as deemed necessary. I understand that I am liable for any expenses incurred due to emergency treatment. I understand all reasonable safety precautions will be taken at all times by the Greater Cincinnati Emmaus Community and its agents during the Walk sponsored by same. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Greater Cincinnati Emmaus Community, its Board of Directors, its leaders, employees or volunteer staff liable for damages, losses, diseases or injuries by the subject of this form.