PROGRAM AND GROUP INFO

 
Wayumi Program*
 
 
 
Choose your date*
 
 
 
How did you hear about this event?*
 
 
 
Previously Attended a Wayumi Program
 
 
 

  
Church/Group Name*
 
 
Position at Church*
 
 
 
 
 
 

PERSONAL INFORMATION

 
Check here if this registration is for a minor.
 
 
 
Check here if this registration is for a leader/chaperone.
 
 
 
First Name*
 
 
Last Name*
 
 
 
Preferred Name
 
 
 
 
Gender*
 
 
DOB*
 
 
 
Email*
 
 
 
Phone*
 
 
 

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

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

  
Please list others attending with your group (they must register individually as well):
 
 
 
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*
 
Preferred 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
 
Dietary Needs
 
 
 
We offer gluten-free menu substitutions when applicable.  Every meal also consists of fresh fruit and vegetable options.
 
 
 
 
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.*