Shuttle Registration & Release Form

I am filling out this form for:*

Airport ShuttleGreyhound Bus Shuttle

Camper's Name*

First NameLast Name

Camper's Date of Birth*

Date

Gender*

Parent / Guardian Name*

First NameLast Name

Parent / Guardian Primary Phone Number*

Area CodePhone Number

Parent / Guardian Secondary Phone Number

Area CodePhone Number

Will camper be flying alone?*

YesNo

Parent / Guardian Email*

example@example.com

Name person(s) accompanying camper:*

Has camper flown on a commercial airline in the past?*

YesNoUnknown

How many bags will camper be checking?*

Will camper have a carry-on bag?*

YesNo

Would you like our office staff to hold camper's return flight ticket during camp?*

YesNo

Would you like our office staff to hold camper's return flight traveling money during camp?*

YesNo

Please indicate the amount and have it in a marked envelope.*

Airline Name:*

Flight #*

Confirmation #

Departure City:*

Departure Time:*

Connecting City (if any):

Connecting City Departure Time:

Arrival Time at Yeager Airport (CRW):*

Arrival Date*

Date

Special Instructions:

Airline Name:*

Flight #*

Confirmation #

Departure Time:*

Connecting City (if any):

Special Instructions:

Will camper be traveling alone?*

YesNo

Name person(s) accompanying camper:*

Has camper traveled on a commercial bus line in the past?*

YesNoUnknown

How many bags will camper be checking?*

Will camper have a carry-on bag?*

YesNo

Would you like our office staff to hold camper's return bus ticket during camp?*

YesNo

Would you like our office staff to hold camper's return bus traveling money during camp?*

YesNo

Please indicate the amount and have it in a marked envelope.*

Bus Line Name:*

Bus #*

Confirmation #

Departure City:*

Departure Time:*

Connecting City (if any):

Connecting City Departure Time:

Arrival Time at Greyhound Bus Station in Charleston, WV:*

Arrival Date*

Date

Special Instructions:

Bus Line Name:*

Bus #*

Confirmation #

Departure Time:*

Connecting City (if any):

Special Instructions:

Comments or Notes:

Authorization and Medical Release

I, the undersigned parent or guardian, hereby authorize The Wilderness Christian Camp & Retreat Center, Inc, or an adult in charge of said task, to transport my child to and/or from Yeager Airport to The Wilderness Christian Camp, making any and all necessary and/or related stops or detours in conjunction with said task.

I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED ON SAID ACTIVITIES, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO. I do hereby agree to hold The Wilderness Christian Camp & Retreat Center, Inc. and its agents, volunteers, and employees, harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child or property, even injury resulting in death, which I now have or which may arise in the future in connection with the activity or participation in any other associated activities.

I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and the terms of this release are contractual. This is a legally binding agreement that I have read and understand.

Authorization and Medical Release

I, the undersigned parent or guardian, hereby authorize The Wilderness Christian Camp & Retreat Center, Inc, or an adult in charge of said task, to transport my child to and/or from Greyhound Bus Station to The Wilderness Christian Camp, making any and all necessary and/or related stops or detours in conjunction with said task.

I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED ON SAID ACTIVITIES, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO. I do hereby agree to hold The Wilderness Christian Camp & Retreat Center, Inc. and its agents, volunteers, and employees, harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child or property, even injury resulting in death, which I now have or which may arise in the future in connection with the activity or participation in any other associated activities.

I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and the terms of this release are contractual. This is a legally binding agreement that I have read and understand.

Parent/Guardian Signature of Acknowledgment and Consent*

Shuttle Registration & Release Form

Arrival Information:

Departure Information:

Arrival Information:

Departure Information: