Register for Super Saturday

Event *Lee's Summit - March 6th 2021Prairie Flower Bible Church - March 20, 2021

Name *

Gender *MaleFemale

Age *

Date of Birth *

Month

Day

Year

Parent / Guardian *

Parent / Guardian Phone *In Case of Emergency

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Email Address *

Church *

Do you have insurance? *YesNo

Insurance Provider *

Name of Policy Holder *

Policy Number *

Pickup Person *

Alergies

Medications

Pre Existing Medical Conditions

Other Important Information

Are you Current on Immunizations? *YesNo

Permission Statement - By clicking submit below, I GIVE PERMISSION for Whispering Winds Bible Camp (WWBC) to secure medical treatment for the participant in case of illness or accident. I GIVE PERMISSION for my child to participate in all activities, at WWBC's Super Saturday Event. I ACKNOWLEDGE AND ACCEPT the risks involved in camp activities. I ACCEPT personal financial responsibility for any bodily injury sustained while my child is at WWBC's Super Saturday Event. Furthermore, I PROMISE to hold harmless WWBC and its representatives for any injury related to Super Saturday. I GIVE PERMSSION for my child to attend Super Saturday and receive the Bible-based instruction provided. I GIVE PERMISSION to use pictures including the participant in organizational publicity. *I Agree

Type Name as Signature *

Parent or Guardian if under 18