| |
|
|
|
|
|
|
* indicates required field
|
|
| *Name: |
|
| *Street Address: |
|
| *City: |
|
*State: |
|
*Zip: |
|
| *Home (or primary) Phone: |
() |
| Work Phone: |
() |
| Cell Phone: |
() |
| *Email: |
|
| *Church: |
|
| Roommate Request: |
|
|
|
|
*Select the Retreat or Event you plan to attend
|
|
|
 |
| Before pressing
submit, to prevent spam please enter the code from the image above exactly as it appears. |
|
|
|
|
Please read the following statement and if you are in agreement with it, please type your name in the box as your electronic signature.
|
Release & Indemnification
I recognize that activities available at WCRC have an inherent risk of injury and I am participating in them willingly. I hereby covenant with WCRC that we will never institute any action at law or in equity for any personal injuries to property, real or personal, caused by, or arising out of these activities. I further agree to indemnify and hold WCRC harmless against any and all cost, damages and expenses, which may be incurred by them as a result of any lawsuit we might file against them. I also give permission for the use of video and/or photographs to be used in camp publicity.
|
| *Electronic Signature: |
|
|
|
|
To complete registration you
may pay the $50 non refundable
deposit or you may specify another amount.
|
|
|
Check the box if you wish to only pay the deposit or type in the amount.
Pay Deposit:
Designate Amount:
*Minimum of $50.00
|
|
Payments (check and credit cards
including VISA, Master Card,
Discover & American Express) are accepted on the secure PayPal site, even if you do not have a PayPal account. Click Submit below to confirm your information and be redirected to the PayPal site for payment.
|
|
|
|
|