Register – MBC Memorial Day Weekend Register – Midwest Bible Church Memorial Day The registration form for Midwest Bible Church to register for Memorial Day Retreat. Step 1 of 4 25% EmailThis field is for validation purposes and should be left unchanged.Family Name(Required)Family Name / Last Name (example: Smith)How many in your registration?(Required)Please have adult children or friends register with their own registration form. This form should register you, your spouse, and your minor children.If adult children and their families are attending this event with you, please have them complete their own registration. Parents of unaccompanied minors must complete their own form for their child, and list the family the child is staying with in shared cabin field.For example, an unaccompanied minor would be a friend of your child who is attending, and staying in your cabin, and you are responsible for this unaccompanied minor. Cabin Sharing Choice(Required)(Private cabin for one family, shared cabin for multiple family groups). Private Shared Who are you sharing cabin with?Enter the last name of the family or families who will be sharing your cabin. 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Include the name of the person registering.NameAgeFood Allergies or Restrictions Add RemoveTo ensure your visit is as enjoyable as possible, we invite you to inform us of any allergies or dietary needs you might have. For more detailed inquiries about our meal preparation, please do not hesitate to reach out to our Kitchen Manager, Tim Bast, at tim@phantomranch.org.Registration NotesPlease add any additional information you think we may need to know. Please enter food allergy information next the name of the person in the above list. Camp Fee – Ages 17+ Quantity Price: $140.00 Quantity Camp Fee – Ages 17+Camp Fee – Ages 7-16 Quantity Price: $85.00 Quantity Camp Fee – Ages 7-16Camp Fee – Ages 3-6 QuantityAges 0-2 are free. Price: $45.00 Quantity Camp Fee – Ages 3-6Camp FeeTrail Ride QuantityIncludes 15 minutes of instructions and approximately 40 minutes of a trail ride. Price: $25.00 Quantity Trail Ride TotalPony Rides QuantityFor children 8 and under. 10 minute ride led by an adult. Price: $8.00 Quantity Pony Ride TotalActivity FeeTotal FeeCamp Fee + Activity FeeYou may proceed to the next page if you have selected fee items. Consent(Required)This RELEASE of LIABILITY is made and entered into hereinafter designated PHANTOM RANCH BIBLE CAMP and hereinafter designated PARTICIPANT. I acknowledge that participation in the activity described above involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. In consideration for the opportunity to participate in the activity described above (the “activity”), the participant (or parent/guardian if the participant is a minor) acknowledges and accepts the risks of injury associated with participation in, supervision if guardian of minor(s) and transportation to and from the activity. The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by Phantom Ranch or its agents, employees, volunteers, or any other representatives (collectively referred to as the “sponsor”). Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise. If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the participant (or parent/guardian) and the activity sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association. I have read this release of Liability and Assumption of Risk Agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement. I also agree that I have the right to assign this agreement to all others listed on this form.Who Completed this Form(Required)Please enter the name of the person completing this form.Email(Required)Please enter the email address of the person completing this form. Phone(Required)Please complete the phone number of the person completing this form. Payment information will be included on the next page, after you submit. Thank you.Payment Method(Required) Pay with check Pay with credit card
