Preview Retreat Preview Retreat Sign-up Form Want to catch a sneak peek at what it looks like to be a part of Rev5? Fill out the information below to register. Step 1 of 2 - Registration 0% Name* First Last Phone*Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Age*Rev5 accepts students age 18-24, but the preview retreat is open to Juniors and Seniors in high school as well.Age161718192021222324Fitness Level*Rev5 is a highly active program, requiring stamina and basic physical fitness. How would you describe your fitness level?Excellent physical conditionAverage physical conditionBelow average physical conditionAdditional 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 Rev5?What are the top 3 reasons why you're interested in Revolution5?Emergency Contact NameIf 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 PhoneEmergency Contact Email Preview Retreat 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 Preview Retreat, (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 Preview Retreat Liability Release. First Last Make PaymentYou will be asked to fill out your payment information on the following page. Price: $50.00 Coupon Total $0.00 Have a unique payment situation? Save the form and send us an email so we can help! Contact Us