Register for Work Week

Name *

Email Address *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Phone *

Birthdate *

Emergency Contact Name *

Emergency Contact Phone *

Emergency Contact Relationship *

Church *

Do you have insurance? *YesNo

Insurance Provider *

Name of Policy Holder *

Policy Number *

Dietary Needs

Alergies

Pre Existing Medical Conditions

Other Important Information

Date of last tetnis shot

Arrival date *

Arrival time *

Hours

Minutes

Departure date *

Departure time *

Hours

Minutes

Permission Statement – By clicking submit below, I GIVE PERMISSION for Whispering Winds Bible Camp (WWBC) to secure medical treatment for myself, my spouse, or my child in case of illness or accident. I GIVE PERMISSION for my child to participate in all Camp activities, both on and off camp property, either by walking or riding in camp vehicles, including (without limitation): hiking, backpacking, canoeing, kayaking, caving, water tubing, low ropes course, climbing wall and swimming. I ACKNOWLEDGE AND ACCEPT the risks involved in camping activities for myself, my spouse, or my child. I ACCEPT personal financial responsibility for any bodily injury sustained by myself, my spouse, or my child while at WWBC. Furthermore, I PROMISE to hold harmless WWBC and its representatives for any injury related to Camp. I GIVE PERMSSION for my child to receive Bible-based instruction while at WWBC. I AGREE for myself, my spouse, and my child to abide by the dress standards and rules of conduct of WWBC. I GIVE PERMISSION for WWBC to use pictures including myself, my spouse, or my child in organizational publicity. *I Agree

Type Name as Signature *

parent or guardian if less than 18