Westside Weekend 2018
First *
Your answer
Last *
Your answer
Email *
Your packing list and final trip details will be sent to this address
Your answer
Church
Your answer
Adult Leader
Your answer
Current Grade *
Youth Home Phone Number *
xxx-xxx-xxxx
Your answer
Youth Cell Phone Number *
xxx-xxx-xxxx
Your answer
Parent/Legal Guardian Name *
Your answer
Parent Home Phone Number *
xxx-xxx-xxxx
Your answer
Parent Cell Phone Number *
xxx-xxx-xxxx
Your answer
Emergency Contact Name and Phone Number (other than parent listed) *
Last, First xxx-xxx-xxxx
Your answer
Who is your health insurance provider? *
Your answer
Please list any medications, health concerns and allergies (including food) here: *
Your answer
T-Shirt Size *
Unisex adult sizing
Workshop Choice #1 *
Workshop Choice #2 *
Workshop Choice #3 *
Alternate Workshop Choice *
Alternate Workshop Choice *
By submitting this form, my child has permission to attend Westside Weekend. I will not hold the camp, its staff, or the event leadership responsible for any injury that might occur. I also give my permission for any emergency medical treatment for my child if necessary. *
Parent/Legal Guardian ONLY, please check
Required
By submitting this form, I understand my registration is not complete until payment is received. Cost is $105 per person and includes t-shirt, all meals and activities except where noted for specific workshops. (Registration must be completed by February 21st to guarantee a T-shirt. Fee will increase to $130.00 for late registrations.) Please make checks payable to your church and submit them to your youth leader. *
Youth leaders only: please have check & name list postmarked to First United Methodist Church (ATTN: WESTSIDE 522 White Avenue, Grand Jct, CO 81501) by February 21. Late registrations will be accepted (on a space available basis) until the event (WSW t-shirt may not be available and late registration fees will increase to $130.00). No refunds will be given but substitutions may be made.
Are you interested in being a small group leader if needed? *
Small group leaders will help facilitate discussions with other youth throughout the weekend.
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