Please fill out a separate registration form for each participant. A 10%
non-refundable deposit is required and will be applied to your tuition. First payment (half of total tuition)
is due in February, 2022. Final payment is due in May 2022. If a minimum threshold
of 20 is not met, the program will be canceled and all money, including deposit, will be
You may still register, space permitting, up until the retreat begins. Cancellation Policy
A $25 cancelled check fee will be charged for returned checks.
Cancellations within 14 days of your arrival will result in a full credit applied toward a future stay at Medomak. In the event Medomak must cancel a program, a full refund will be given.
Cancellations must be made by speaking with a Medomak Director.
Check-In is between 3:00pm-5:00pm on Monday, August 14th.
Check-Out is by 10:00am on Sunday, August 20th. "Note to participants intending to register as a household: a separate registration (and payment) must be completed for each individual."
If you have any questions please call us at 1-866-Medomak, Monday-Friday 9AM - 5PM.
* ZIP / Postal Code Phone * Phone * Email *
Price includes Maine state meals and lodging tax.
Do you know with whom you are sharing your cabin? Name of cabin mate. (They will still need to register and pay separately from this registration)
If you would like to share a cabin, but don’t have a specific person in mind, please provide us with the following information so that we can best match you with a suitable roommate. We will do our very best to pair participants, but we cannot guarantee outcomes.
Your Age Sleep Questions
Please check all that apply.
Van Ride from Portland Airport to Camp? (@$55.00) * Van Ride from Camp to Portland Airport? (@$55.00) * Total Due
Expected Arrival Time * How did you hear about us? T-Shirt Size Men's Small Men's Medium Men's Large Men's X-Large Men's XX-Large Men's XXX-Large Ladies' Small Ladies' Medium Ladies' Large Ladies' X-Large Additional Comments
MEDOMAK RETREAT CENTER
PERSONAL INFORMATION & ACTIVITY WAIVER
Welcome to the Medomak Retreat Center! We’re excited that you will be joining us for the
Medomak Astronomy Retreat and Symposia. To serve you better while you are here, please provide us with the following
Waiver Name *
Phone * Phone * Email *
Date of Birth *
MM slash DD slash YYYY
This is my _____________ retreat at Medomak. * Select One first second third fourth fifth sixth seventh eighth ninth tenth eleventh twelfth thirteenth fourteenth fifteenth sixteenth seventeenth eighteenth nineteenth twentieth Date of Last Tetanus Shot *
MM slash DD slash YYYY
Date of Last Physical *
MM slash DD slash YYYY
Allergies * Medications You Take * Have you had recent or past medical conditions or treatments that could affect participation in physical camp activities? If so, please describe. * Dietary Considerations We provide well-balanced, varied meals. With notice, we can accommodate vegetarian/vegan diets. All meals have essential components that are gluten free, but folks with celiac disease may be concerned that our kitchens cannot account for cross-contamination. Folks that prefer to eat gluten free may wish to bring along personal items to supplement their preferences.
If you would like Vegetarian or Vegan meals please select below. Swimming Ability * Non-swimmer Novice Intermediate Advanced
Emergency Name *
Relationship Emergency Phone * Emergency Phone *
Primary Care/Family Physician * Physician Phone * Physician Phone * Insurance Provider * Group Number * Additional Information You'd Like to Provide
Retreat Center Waiver
We all must be fully aware that there are potential risks and dangers inherent in engaging in outdoor recreational activities and in living in an outdoor camp environment. To heighten awareness, upon arrival at the Retreat Center, each retreat participant (as well as any adult or minors accompanying the retreat participant) must participate in a mandatory safety orientation where retreat center rules and regulations are discussed. As part of the orientation each participant and accompanying adult or minor(s) will have the opportunity to ask questions or seek clarification as to any issues related to being at the retreat center. The majority of the rules are cited in our Campers Handbook. We advise retreat participants to review the Handbook upon arrival at the retreat center. A copy of the Handbook can be found in your cabin. If you would like to obtain a copy of the Handbook prior to coming to camp, you can contact Medomak Camp by email or phone to receive a paper copy.
Each of the retreat participants (and other adults or minors accompanying the participant) as entered in the registration form, acknowledge will take the opportunity once at the retreat center to read the Camper Handbook, discuss any issues with companions or ask any questions of Medomak Camp staff. Through this means, additional information provided on the Medomak Camp website, and conversations with Medomak Camp staff, entry of each name further signifies that retreat participants and any adults or minors accompanying are making an informed decision regarding attendance at Medomak Retreat Center, and understand and accept all of the terms of attending Medomak Camp and Retreat Center. Entry of each name acknowledges further understanding and agreement that all activities undertaken by any retreat participant (or person accompanying the retreat participant) are done so “at your/their own risk.” Further, entry of each name acknowledges
agreement to release Medomak Camp and Retreat Center, its owners, officers, employees, agents, and representatives from any and all claims for loss or damage of property and/or personal injury sustained at Medomak Camp or Retreat Center while engaging in activities associated with Medomak Camp or Retreat Center.
I agree *
Consent of Use of Photos and Statements
We have found that over the years, the photos and comments provided by attendees of Medomak are our best kind of marketing. The impact of individuals telling others of their experience at our family camp and/or retreat center has proven very powerful in our effort to grow and be successful. By signing this consent, you are agreeing to let us use any photos or comments that we can attribute to your time at the camp or retreat center. Please do not feel obligated to sign this consent. However; if you do sign, we want to thank you for your consideration.
I agree that photographs and statements of or about my experience at the Medomak Retreat Center may be used in promoting the camp or its related activities.
I consent the use of photos and statements. *
Permission to Treat
Any/all activities in which you engage at Medomak Retreat Center are “at your own risk”, and unfortunately there are occasional opportunities for injuries. For the typical situation at Medomak Retreat Center, should any accident with injury occur, participants are usually able to act on their own behalf to make decisions as to the type and extent of medical treatment. Medomak staff on hand at the time will always seek to assist based on their first-aid training in consultation with the participant. Should an adult be injured such that they are unable to exercise their authority to make a decision as to type and extent of medical treatment, Medomak staff may need to take immediate action. To allow for immediate treatment should you not be able to exercise your authority, Medomak requires that you give permission for Medomak staff, in consultation with medical personnel, to provide either routine or emergency medical treatment.
Entry of your name in the statement below signifies that you grant permission for Medomak to provide medical treatment as provided in the statement. A parent or guardian may acknowledge approval for any minors (under 18) under their expressed guardianship.
I grant Medomak personnel, as well as other medical personnel selected by the Medomak Director to administer medical treatment, including hospitalization; to administer medications; to order X-rays, routine tests, treatment; to release any records necessary for insurance purposes; and to provide or arrange necessary related transportation for the named person who is attending a retreat or conference at Medomak Retreat Center. In the case of any minor (less than 18 years) this approval applies in the event the parent/guardian cannot be reached in an emergency. In the case of an adult, approval applies if in the opinion of the Medomak Director the injured adult is unable to participate in medical decisions. This completed form may be photocopied for trips away from the Retreat Center.
Permission granted. *
CORONAVIRUS / COVID-19 WARNING & WAIVER
COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. COVID-19 can lead to severe illness, personal injury, permanent disability, and death. The COVID-related policies and procedures developed and put forward as part of the process whereby each prospective retreat participant registers are designed to the fullest practical extent possible to minimize risk of infection and/or spread of the virus to participants as well as any person accompanying participants who will be attending the retreat or occupying any part of the Medomak Retreat Center property.
As a registered participant of a Medomak Retreat Center retreat or conference program, I have thoroughly read Medomak Retreat Center’s
COVID policies and procedures. I have exercised the opportunity to ask Medomak Retreat Center representatives all questions that I deem necessary to make an informed decision regarding occupancy and/or retreat attendance at Medomak Retreat Center. By affirming this waiver, I understand and accept, and agree to the best of my ability to observe and adhere to the COVID-related regulations stipulated in the Medomak COVID policies and procedures. Specifically, my endorsement signifies compliance with procedures that relate to:
Requirement for Vaccination
Monitoring and Testing while at Medomak
Medomak Mask Policy
I agree on behalf of myself as well as any minor in my custody either occupying the Medomak Camp and Retreat Center property and/or attending the retreat to release Medomak Camp and Retreat Center, its owners, officers, employees, agents, and representatives from any and all claims that relate to any illness due to COVID infection acquired during or as a result of my occupancy on the Medomak property or participation in the retreat.