Blue Lotus Family Retreat

Epilepsy Families Southeast Wisconsin welcomes you to attend a Social at the Blue Lotus Farm and Retreat Center:

Saturday, June 4th, 11am-3pm

Blue Lotus Farm and Retreat Center
5501 County Road M
West Bend, WI  53095 - Map
 (262) 675-2473

There are trails, bicycling, boating, fishing (life jackets provided and required), and an abundance of games.

Boxed lunch and beverages will be provided.

Please complete the following registration for each attendee, including each child.


The person and/or persons named on this registration form wishes to participate in the Social (Event) on Saturday, June 4th, 11am-3pm in West Bend, WI. Those who have made this possible - Epilepsy Families Southeast Wisconsin, the Event Sponsors, volunteers and officials (collectively, the "Organizers") wish to ensure to the fullest extent possible that they will not be sued or held liable for injuries or damages sustained to participants or those attending the Event. In return for being allowed to participate in the Event.

  1. I/we assume all risk of participating and attending this event;
  2. I/we understand the Organizers of the Event are relying upon the agreements and representations I/we make here;
  3. I/we release the Organizers of the Event from all claims, including negligence claims and claims relating to personal injury or property arising out of this, my/our participation or attendance at this Event, except, I/we do not release reckless or intentional tort claims;
  4. I/we agree to indemnify the Organizers if I/we or anyone else brings a claim against the Organizers due to injuries I/we receive due to my participating or attending the Event ("indemnity" here means to reimburse the Organizers for any sums they have to pay and expenses/fees they incur to any injury claim relating to me);
  5. I/we give permission for the free use of my name and picture in any broadcast, print media account, or promotion of this Event;
  6. I/we have carefully read this document and understand it. If I/we am under 18 years of age, my/our parent or guardian is signing on my/our behalf, and my/our parent or guardian also agrees to indemnify the Organizers if I/we or anyone else brings claims against the Organizers due to injuries I/we receive due to my/our participating or attending the Event. With knowledge of the risks involved and the rights I/we give up, I/we waived the rights I/we might otherwise have, and freely sign this agreement document.