Registration: Gathering 2017
October 27-29, 2017
Webster Conference Center, Salina, Kansas
Email address
Congregation
Your answer
Adult #1 (Last Name, First Name)
Your answer
Adult #2 (Last Name, First Name)
Your answer
Address
Your answer
City , State, ZIP
Your answer
Phone Number
Your answer
Children/Youth
If you are registering children up to 5th grade for children's activities, we ask that you volunteer during the weekend to assist with one of the time blocks for those activities. Please enter the name and cell phone number of the family member (15 or older, please) who will be helping.
Your answer
Children/Youth Registrant Information
If you have no children to register, please scroll down to the Lodging section.
Preferred Time to Assist
Please check the preferred time blocks.
Your answer
Child/Youth #1: Age
Child/Youth #1: Grade
Child/Youth #1: Medical Permission/Liability Forms
Medical Permission/Liability Form is required for children infant--5th grade. A Challenge Course Liability form is required for youth 6th-12th grades, if they wish to participate in the ropes course. Download forms at www.wpcob.org.
Child #1: Activities
If this child is infant–5th grade, please indicate which activities s/he will participate in. If the child is 6th grade or older, skip this question.
Child/Youth #1
Your answer
Child/Youth #2: Age
Child/Youth #2: Grade
Child/Youth #2: Medical Permission/Liability Forms
Medical Permission/Liability Form is required for children infant--5th grade. A Challenge Course Liability form is required for youth 6th-12th grades, if they wish to participate in the ropes course. Download forms at www.wpcob.org.
Child #2: Activities
If this child is infant–5th grade, please indicate which activities s/he will participate in. If the child is 6th grade or older, skip this question.
Child-Youth #3: Name
Your answer
Child/Youth #3: Age
Child/Youth #3: Grade
Child/Youth #3: Medical Permission/Liability Forms
Medical Permission/Liability Form is required for children infant--5th grade. A Challenge Course Liability form is required for youth 6th-12th grades, if they wish to participate in the ropes course. Download forms at www.wpcob.org.
Child #3: Activities
If this child is infant–5th grade, please indicate which activities s/he will participate in. If the child is 6th grade or older, skip this question.
Child/Youth Special Needs, Additional Information
Please provide any information that caregivers or activity directors might need about the children/youth above, e.g., allergies, food sensitivities, special needs, etc.
Your answer
Lodging
Housing is "winterized camp" stye with bunk beds, decent mattresses, and two handicapped-accessible rooms. Room assignments will be made in the order registrations are received as there are a limited number of beds. Normally six persons of the same sex share a room with in-room bath facilities. A few "family" rooms may be available by special request. Bring your own bedding (including pillows) and towels. Youth will be housed in their own dorm with separate facilities for boys and girls. They must have a signed permission form to participate in the Challenge Course (form available at wpcob.org). RV hookups are available for those preferring that housing option. Webster policy does not allow pets on campus or in campus housing.
Lodging Options
Special Lodging Needs
If you are reserving a conference center camp room, please specify any special needs you may have.
Your answer
Meals
Meal Options
Please check all meals that you (and your family) will attend.
Special Meal Needs
Please specify any special dietary requirements.
Your answer
Registration Fee
The Gathering and Youth Retreat are highly subsidized by the Western Plains District.

Please mail checks at the time you submit this registration! Make checks payable to "Western Plains District" and mail them to Registrar Wylene Lengel: 1360 N. Walnut, McPherson KS 67460

If you are registering by October 16
Please choose one and mail check to above address
If you are registering after October 16
Please choose one and mail check to above address
You Must Click Submit!
Photography and Video Tape: As an attendee of a public event be aware that you could be pictured in still photos or video taped footage used to interpret, summarize, or promote The Gathering and the ministry of the Western Plains District. If you have questions, please contact the District Office at (620) 241-4240 or wpdcb@sbcglobal.net.
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms