Register – Triple W Retreat Register – Triple W Retreat Step 1 of 2 – Family Information 50% PhoneThis field is for validation purposes and should be left unchanged.Camper Name(Required) First Last Camper Grade(Required)Camper Food Allergies or Dietary RestrictionsPlease do not enter ‘none’, ‘N/A’, or other words indicating there are not any food allergies. A blank line is enough.Bunkmate and Registration NotesBunkmate preferences, if any. Please add any additional registration information you think we may need to know.To ensure your visit is as enjoyable as possible, we invite you to inform us of any food 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. You will be asked to complete a separate camper medical form after we process this registration. 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Email(Required)Please enter the email address of the person completing this form. 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 full name of the person completing this form.Total FeePayment Type(Required) Pay with check Pay with credit card Payment information will be included on the next page, after you submit. Thank you.
