Winter Blast III - Sat. Feb. 9, 2008 - ages 10-12  Register Here

Winter Blast I & II were a great success!  Check out the photo gallery!  There's still room for more in Winter Blast III for ages 10-12 - Sat. Feb. 9.

Winter Blast III - Sat. Feb. 9, 2008 - ages 10-12

 

 

Winter Blast III  - Registration Form:

 

 Child First Name
 Child Last Name
 Date of Birth 
 ex. (03-09-1998)
 Age at time of camp
 Current Grade    
 Gender Male     Female
 Parents Names
 Address
 City
 State
 Zip
 Phone 1
 Phone 2 (emergency, 
 work, cell, other)
 Email Address
 Church (if any) None
  School
 Has this child been to a 
 summer camp at Woodcrest 
 before?
Yes     No
 Optional: Name of friend 
 (for
"Bring a new friend" 
 discount described above.)
A registration form for this child must also be submitted, if not already.
 Optional: Name of friend 
 as a
groupmate (Must be mutual)
A registration form for this child must also be submitted, if not already.

Any significant 
health concerns 
or allergies 
that we should 
be aware of.

I/We hereby acknowledge that I am/we are the parent(s)/legal guardian(s) of the camper registered above, and as such parent(s)/legal guardian(s), I/we hereby authorize my/our child to participate in the camping program at Woodcrest Retreat ("Camping Program"). 

I/We also authorize Woodcrest Retreat to use photographs and/or video of my/our child in camp publicity.

I/We acknowledge and understand that the Camping Program involves a wide variety of formal and informal indoor and outdoor recreational and learning activities and that participation in the Camping Program is an activity which could result in personal injury or illness to my/our child. With full knowledge of the risks associated with my/our child's participation in the Camping Program, I/we, on behalf of myself/ourselves, and my/our child, hereby absolve, release and discharge Woodcrest Retreat, its officers, directors, members, employees and agents, and any individual directly or indirectly involved with the Camping Program from any liability for injury or illness suffered by my/our child while participating in or as a result of the Camping Program. In the event my/our child should suffer an injury or illness while participating in or as a result of the Camping Program, I/we hereby authorize and consent to any and all medical treatment which may be determined by a physician, other qualified medical personnel or the officials of the Camping Program to be necessary or desirable for my/our child and hereby authorize the officials of the Camping Program to use their discretion to have my/our child transported to a medical facility for such treatment. 

Authorize Consent here:  

Please type your full name:

    


 

 

 

 

 

 

 

 

Woodcrest Retreat
225 Woodcrest Drive
Ephrata, PA  17522
(717) 738-2233
info@WoodcrestRetreat.org