2026 YSC Micro Retreat: Portland Registration Form

Attendee Information 





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YSC is a 501(c)3 nonprofit organization that relies on donations to provide programs and education to the young breast cancer community. We ask the following questions in an effort to be transparent about exactly who we are able to reach and serve. These questions are entirely voluntary, and we do not share this information about you with others.











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October 10, 2026 · Sellwood-Moreland · Portland, OR

I am accepting this waiver electronically during the event registration process, before taking part in any retreat activities. My participation is voluntary, and I confirm the following.

I am at least 18 years of age.

Release. "Released Parties" means Young Survival Coalition (YSC) and its officers, directors, employees, agents, volunteers, presenters, and sponsors; and the local Peer Space and its owners, operators, and employees. On behalf of myself, my heirs, executors, and administrators, I release the Released Parties from, and hold them harmless against, any and all costs, injuries, losses, or damages of any kind, including death and bodily injury, arising directly or indirectly out of my participation in the 2026 Portland MBC Micro-Retreat or in any related session, meal, activity, or gathering, whether on or off event property. This is a full general release of those claims, whether or not I know about them now. It does not extend to gross negligence or willful misconduct, or to any claim that cannot lawfully be released under Oregon law.

Activities and risk. The retreat includes activities that carry inherent risk, including but not limited to: Qi-gong, sound bath, and other outdoor activities; interaction with animals; an outdoor fire feature; and meals and refreshments served throughout. My participation in each activity is optional. I accept these risks and will participate only within the limits of my own ability and comfort.

Health. I am physically able to participate in the activities I choose to join, and if I am under treatment for any physical or mental health condition that could affect my participation, I have consulted my medical care provider. YSC does not provide medical care, supervision, or advice, and presenters are not acting as my healthcare providers. I am solely responsible for my own health and safety, for my personal property (including anything left in a session space), and for any medical costs I incur.

Conduct. I will follow YSC's rules and all applicable laws. YSC staff may direct or halt my participation at any time to protect safety, and may remove anyone who disobeys rules or endangers a person or property. I will not bring illegal substances or drug paraphernalia; knives, guns, or weapons; open-flame or fire-starting items; fireworks or explosives; or clothing, props, or equipment that pose an unnecessary risk. This applies to items I bring, not to equipment YSC or the venue provides and supervises. YSC may search personal belongings at its discretion. All information I have submitted to YSC is accurate.

Media. I grant YSC the absolute right and permission to use my name, biographical information, likeness, photograph, and any video or audio recording of me taken during the retreat, in any media worldwide, without further notice or compensation, including disclosure of my name on YSC's website. I have no right of approval and no claim arising out of its use, alteration, or presentation.

Electronic signature. I agree that checking the box below and submitting this registration form is my electronic signature, and that it has the same legal effect as a handwritten signature. I consent to accepting this waiver electronically and understand I may request a copy from YSC.