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620-692-3695
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18487 Barber Road
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Fall River, KS 67047-9610
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Leadership Development Week Signup
Camper Name
*
Address
*
(Street Name, City, State, Zip)
Email
*
Gender
*
Male
Female
Cell Phone
Grade Completed this Spring
*
9th
10th
11th
12th
Home Church
Town
Pastor or Youth Director's Name
Parent's (Guardian) Name
Parent (Guardian) Contact Phone Number
Alternate Phone Number
Signature
*
Agree
I hereby authorize medical treatment by a licensed hospital at the discretion of Brian or Diane Wheeler for the above-named youth/adult at this trip sponsored by the Westminster Woods Camp & Retreat Center, Inc. I also hereby authorize the making of photographs, motion pictures, videotapes, recording or other memorializing of said event and for my participation therein, and the publication of other use thereof, I waive any right to compensation therefore or any right that I otherwise might have to limit or control such making or use. I agree to cooperate and conform to directions and instructions of personnel responsible for activities. I will indemnify and hold harmless Westminster Woods Camp & Retreat Center, Inc. and its officers, agents, servants, or employees from any and all claims or causes of action by myself or by any other person or entity, and under no circumstances will present any claims against said organization and said persons for personal injury, property damage, wrongful death caused by an act of negligence by the camp Recourse for the payment of any hospital, medical, dental, or related cost and expenses will be paid either by me or my accident, hospital, or medical insurance, or any available benefit plan of mine.
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2019
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Sign up Dates
Dates - 3rd & 4th Grade Camp - May 31st to June 4th and 5th & 6th Grade Camp - June 6th-11th Due to the volume of participants: - Freshmen can only participate in ONE week of the Service LDP program. - All other grades can participate for one week of each Service LDP & Leadership LDP for a total of two weeks.
I am a freshman who wishes to participate in the Service LDP Week
3rd & 4th Grade Camp
5th & 6th Grade Camp
I am a sophomore, junior, or senior who wishes to participate in the Leadership LDP Week
3rd & 4th Grade Camp
5th & 6th Grade Camp
I am a sophomore, junior, or senior who wishes to participate in the Service LDP Week
3rd & 4th Grade Camp
5th & 6th Grade Camp
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