Outdoor Leadership School Registration 2024 Name(Required) Email(Required) Phone(Required)Address(Required) Street Address Address Line 2 City State ZIP Dietary needs, check all that apply:(Required) None Vegetarian Gluten Free Vegetarian/Dairy Free Vegan Vegan/Gluten Free Gluten Free Gluten Free/Dairy Free Dairy Free Restriction/Allergy/Intolerance Intolerant/allergic to: Lactose Nuts Soy Seafood Eggs None Other Allergy (specify) WILDERNESS WATER SAFETYSelect your course fee: WWS-Standard Course Fee and Lunches: $285* WWS-Standard Course Fee, Lodging & Meals: $415* WWS-Manito-wish Staff Course Fee, Lodging & Meals: $215* *A deposit of $190 or full fees are due at the time of registration. Please submit payment (check or credit card) with this form.Select your course date: May 23-24 June 10-11 (Manito-wish Staff Only) June 8-9 (Manito-wish Staff Only) July 8-9 (Manito-wish Staff Only) WILDERNESS FIRST AIDSelect your course fee: WFA-Standard Course Fee and Lunches: $310* WFA-Standard Course Fee, Lodging & Meals: $415* WFA-Manito-wish Staff Course Fee, Lodging & Meals: No Charge *A deposit of $285 or full fees are due at the time of registration. Please submit payment (check or credit card) with this form.Select your course date: May 21-22 June 10-11 (Manito-wish Staff Only) June 8-9 (Manito-wish Staff Only) July 6-7 (Manito-wish Staff Only) WILDERNESS FIRST RESPONDER 5-DAY TRAININGSelect your course fee: WFR5-Standard Course Fee and Lunches: $830* WFR5-Standard Course Fee, Lodging & Meals: $1,100* WFR5-Manito-wish Staff (if required for position) Course Fee, Lodging & Meals: $465* WFR5-Manito-wish Staff (if not required for position) Course Fee, Lodging & Meals: $605* *A deposit of $365 or full fees are due at the time of registration. Please submit payment (check or credit card) with this form.Select your course date: May 2-6 May 14-18 WILDERNESS FIRST RESPONDER RECERTIFICATIONSelect your course fee: WFRRE-Standard Course Fee and Lunches: $395* WFRRE-Standard Course Fee, Lodging & Meals: $515* WFRRE-Manito-wish Staff Course Fee, Lodging & Meals: $255* *A deposit of $225 or full fees are due at the time of registration. Please submit payment (check or credit card) with this form.Select your course date: May 4-6 May 16-18 BEHAVIORAL FIRST RESPONDER TRAINING Select your course fee: BFR-Standard Course Fee and Lunches: $315* BFR-Standard Course Fee, Lodging & Meals: $415* BFR-Manito-wish Staff Course Fee, Lodging & Meals: $150* *A deposit of $250 or full fees are due at the time of registration. Please submit payment (check or credit card) with this form.Select your course date: May 19-20 May 31-June 1 ROPES COURSE CERTIFICATION & SKILL DEVELOPMENTHiddenSelect your course fee: Standard Certification Course Fee and Lunch: $200* Standard Certification Course Fee, Lodging & Meals: $250* Skill Development Fee, Lodging & Meals: $350* *A deposit of $200 or full fees are due at the time of registration. Please submit payment (check or credit card) with this form.HiddenSelect your course date: May 20 (Certification Course) May 17-19 (Skill Development) Payment OptionsREGISTRATION FORM WILL NOT BE ACCEPTED WITHOUT DEPOSIT AND SIGNATURETotal fees due: Less Required deposit(s): Balance due by start of course: MANITO-WISH STAFF! Please check appropriate boxes. I will be working in the following programs in 2024.(Required) Summer Camp Outpost Leadership Not Manito-wish Staff Camp Manito-wish accepts the following forms of payment. Note credits payments will be charged a 2% convenience fee upon processing. Please make your selection below.(Required) E-Check Credit Card with 2% fee Paper Check (please mail to: Camp Manito-wish YMCA, PO Box 246, Boulder Junction, WI 54512) Payment amount to process today (minimum of required deposits)(Required) Bank Name (for eCheck) Account Type (for eCheck) Checking Savings Bank Routing Number (for eCheck) Please confirm routing number before continuingBank Account Number (for eCheck) Please confirm account number before continuingCredit Card Type (2% convenience fee will be added) Visa Mastercard Discover American Express Credit Card Number Please confirm number before continuing.Expiration Date (mm/yyyy) Security (CVV) Code The security code on the back of your card.Cardholder Address (if different than above) Street Address Address Line 2 City State ZIP LegalAcknowledgements I agree to the following:Payment Information & Cancellation Policy: Your deposit secures a space in the selected course. The remainder of payment must be completed on the first day of class. Deposits are fully refundable if you cancel up to six weeks before the course start date or if Camp Manito-wish YMCA cancels the course. If you cancel less than six weeks before the course start date your entire deposit will be forfeited. Waiver information: I understand that although Camp Manito-wish YMCA has taken reasonable steps to provide appropriate training, equipment and skilled staff for my/my child’s camp experience, I acknowledge that some inherent risks cannot be eliminated without destroying the unique character of these activities. Such risks include, but are not limited to, those associated with canoeing, portaging, backpacking, sea kayaking, waterfront activities, wildlife, vehicle transportation, and other components of the camp experience and wilderness travel. Aware of the risks and willing to assume them, I hereby waive, release and agree to hold harmless the Camp Manito-wish YMCA Inc., their representatives and successors for all claims or liabilities of any kind arising out of my/my child’s participation in this camp experience. I have read the descriptions of the session, understand the requirements for participation, and give my child permission to participate. I assume and accept full responsibility for his/her participation. IN CASE OF EMERGENCY, I hereby give my permission to Camp administration to hospitalize, secure proper treatment for, and order injection, anesthesia or surgery for me or my child. I accept responsibility for medical/surgical treatment charges which may be incurred on my/my child's behalf. Signature(Required) *must be signed by parent or guardian if participant is under the age of 18Date(Required) MM slash DD slash YYYY CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
