PROGRAM AND GROUP INFO

 
Wayumi Program*
 
 
 
Which date would you like to register for?*
 
 
 

Please choose your group below. If your group is not listed and it has already been registered, please email us at wayumi@ntm.org. Otherwise, click here to register your group.

 
Choose Your Group*
 
 
 
 
 
 

PERSONAL INFORMATION

 
Check here if this registration is for a minor.
 
 
 
Check here if this registration is for a leader/chaperone.
 
 
 
Check here if this registrant has previously attended.
 
 
 

  
First Name*
 
 
Last Name*
 
 
 
Gender*
 
 
DOB*
 
 
 
Email*
 
 
 
Cell Phone*
 
 
 

  
Address*
 
 
 
City*
 
 
State / Province*
 
 
 
ZIP / Postal Code*
 
 
Country*
 
 
 

  
Arrival Information*
 
 
 
We are only able to transport to/from State College (SCE) - $50.
Please email us with any additional arrival information (including flight details once known). 

  
Check here to register additional family members from the same household.
 
 
 
All other information from the main registration will be applied to each additional family member listed below.
Please submit a separate registration if not from the same address/household.
If the registrant does not have a personal email or phone number, please leave the field blank.
 
First Name*
 
Last Name*
 
Date of Birth*
 
Gender*
 
Relationship*
(to Main Registrant)
 
Email*
 
Phone
Allergies
Dietary Needs
Attended Before?
Leader/Chaperone?
 
 
 
 
 
 
PARENT/GUARDIAN INFORMATION
 
Name*
 
 
 
Email*
 
 
 
Phone*
 
 
 
 
 
 
EMERGENCY CONTACT INFO
 
Check here if parent/guardian is also the emergency contact.
 
 
 
Name*
 
 
Relationship*
 
 
 
Phone*
 
 
Email*
 
 
 
 
MEDICAL INFORMATION
 
Allergies
 
 
 
Allergies Other
 
 
 
Medically Necessary Dietary Restrictions
 
 
 
Due to the higher costs of gluten-free and dairy-free menu items, there will be an additional charge of $10 for these options ($20 for weeklong programs). We do offer fresh fruit and vegetable options with every meal.  If you require other special dietary needs, you may need to bring supplemental food.
 
 
 
 
MEDICAL RELEASE
 
In case of emergency, I hereby give my permission to the physician chosen by Ethnos360’s staff to hospitalize and/or secure proper treatment for, and order injections, or anesthesia, or surgery for myself. 
I have read and agree to the Medical Release.*
 
 
 
 
LIABILITY RELEASE
 
Although Ethnos360 desires to provide a safe and enjoyable time for all persons that come onto its property and make use of its facilities, I understand that there are risks/dangers involved with participation in such associated activities. Some risks that may result in participating could include but not be limited to: pain or bruising, possible injury from sliding or falling, sprains or injury from running over uneven ground, possible eye, nose or ear injury. In consideration of my being allowed to participate in such events at the property of Ethnos360, I assume the entire responsibility and liability for any and all injury of any kind or nature, whatever and assume reasonable risks associated with such activities. I agree to hold harmless Ethnos360, its affiliated organizations, employees, agents, and representatives, from any and all claims arising from my participation.

I agree to indemnify and save harmless Ethnos360, its officers, agents and employees from any and all such claims, loss, expense, legal fees, that Ethnos360 may suffer or sustain as a result of any claim that might be made against it and I do further hereby assume the defense of any action at law or in equity which may be brought against Ethnos360 as a result of my participation. Also, for promotional purposes, Ethnos360 has my permission to use pictures or videos that happen to include me. 
I have read and agree to the Liability Release.*
 
 
 
 
PROGRAM FEE
 

GROUPS/CHURCHES

If you are coming as part of a group or church, connect with your group coordinator to see if they will be collecting the program fee for your group.  They may want the payment submitted to the church or group organization.

*If your group coordinator IS NOT collecting the program fee, you will receive an individual Square invoice with payment instructions by email.



INDEPENDENT/SELF-STUDY

You will be receiving a Square invoice with payment instructions by email.



In the event you must cancel, the following fees will apply:

  • 11-15 days before the program starts: Retreat ($20); Course ($50)
  • 0-10 days before: Retreat ($50); Course ($100); Expedition ($100)