Kingdom Catalyst Kingdom Catalyst Want to take a leap forward in your leadership growth? Fill out the information below to register for a powerful weekend with us! Step 1 of 2 - Registration 0% Name* First Last Phone*Email* Address* City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State How old are you?*Fitness Level*Excellent physical conditionAverage physical conditionBelow average physical conditionKingdom Catalyst may involve activities requiring stamina and basic physical fitness. How would you describe your fitness level?Additional Medical InfoPlease provide any health information that might impair your ability to exercise or perform athletically.Describe your relationship with Christ.*How did you hear about Kingdom Catalyst?*What are you most excited to gain from your Kingdom Catalyst experience?*Are you married?NoYesWill your spouse be joining you?NoYesSpouse Name First Last How old is your spouse?*Spouse Fitness Level*Kingdom Catalyst may involve activities requiring stamina and basic physical fitness. How would you describe your spouses fitness level?Excellent physical conditionAverage physical conditionBelow average physical conditionSpouse Additional Medical InfoPlease provide any health information that might impair your spouse's ability to exercise or perform athletically.Are you under 18 years old?*NoYesEmergency Contact Name*If you are under 18 years old, please list your legal guardian as your emergency contact person. They will receive an email with a digital Release of Liability waiver that must be signed and submitted before you can participate in Rev5 activities. First Last Emergency Contact Phone*Emergency Contact Email* Kingdom Catalyst Liability Release I HEREBY VERIFY THAT I AM AT LEAST 18 YEARS OF AGE, AND I ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH Revolution5 Leadership Institute and/or Revolution5 Kingdom Catalyst event, (hereinafter referred to as "Rev5"), of 2621 W. Cucharras, Colorado Springs, Colorado, 80904 and/or use of the property, facilities and services of Rev5, and I agree to the following: I recognize that there are certain inherent risks associated with attending Rev5, and I assume full responsibility for personal injury to myself, and further release and discharge Rev5 for injury, loss or damage arising out of my presence upon the facilities of Rev5, whether caused by the fault of myself, Rev5 or other third parties. I agree to indemnify and defend Rev5 against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my use of or presence upon the facilities of Rev5. I agree to pay for all damages to the facilities of Rev5 caused by my negligence, reckless, or willful actions. I certify that there are no health-related reasons or problems that preclude my participation in the preview retreat. I acknowledge that Rev5 may involve a test of a person's physical and mental limits, and I release them from liability for the risk of property loss and risks caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to, participants, volunteers, staff, officers and/or other contributors to Rev5. These risks are not only inherent to participants, but are also present for staff and volunteers. (A) I WAIVE, RELEASE, AND DISCHARGE Rev5, and/or its directors, officers, employees, volunteers, representatives, sponsors, volunteers, teachers or assigns, from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me, including my traveling to and from Rev5: (B)I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in Rev5, whether caused by the negligence of release or otherwise. I acknowledge that Rev5 and its directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during Rev5. I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by Rev5, its producers, sponsors, and assigns. I agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions or directions given by Rev5, or the employees, representatives or agents of Rev5. I CERTIFY THAT I HAVE READ THIS DOCUMENT AND THAT I UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A DIGITAL RELEASE OF LIABILITY AND A CONTRACT, AND I SIGN IT OF MY OWN FREE WILL. I FURTHER UNDERSTAND THAT BY SUBMITTING THIS DIGITAL RELEASE OF LIABILITY FORM, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS. Digital Signature*By giving my digital signature, I verify that I have read and agree to the Kingdom Catalyst Liability Release. First Last Single RegistrantYou will be asked to fill out your payment information on the following page. Price: $50.00 Married RegistrantYou will be asked to fill out your payment information on the following page. Price: $75.00 Coupon Total $0.00 Have a unique payment situation? Save the form and send us an email so we can help! Contact Us