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 necessaryfor the Participant, every attempt will be made to contactthe individual designated as “Emergency Contact Person.”Only if that person cannot be reached in an emergencyduring the Emmaus Walk for which permission has beengranted for the Participant to participate, I hereby give mypermission to the Emmaus Leadership Team to hospitalize atpreferred hospital (or any hospital reasonably accessible),secure medical treatment and order and injection,anesthesia or surgery for myself as deemed necessary. Iunderstand that I am liable for any expenses incurred due toemergency treatment. I understand all reasonable safetyprecautions will be taken at all times by the GreaterCincinnati Emmaus Community and its agents during theWalk sponsored by same. I understand the possibility ofunforeseen 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 volunteerstaff liable for damages, losses, diseases or injuries by thesubject of this form.