Tahquitz Pines (map) 55251 South Circle Drive Idyllwild, CA, 92549 United States ✚ gCal ✚ iCal REGISTRATION PACKET MEDICATION AND INHALER FORM STAFF REGISTRATION FORM Midwinter Staff Registration *This registration form is for midwinter staff only* Midwinter 2019 is from February 16-18 at Tahiquitz Pines. Payment must be sent in separately. For questions, please contact your director. Name * First Name Last Name Email Address * Phone * (###) ### #### What is the best way to reach you? * Email Phone Address * Please enter your full address Address 1 Address 2 City State/Province Zip/Postal Code Country Church * T-shirt size How are you actively growing in your faith/relationship with God? * How have you seen God work in your life recently? * List food allergies, if any: * List medications you are bringing, if any: * Consent to background check * Do you give your consent to a background check in the event one has not been done in the last three years? Yes No Upon completing this form, please make payment of $150 to PCJC. There is a $50 fee for any cancellations. There are no cancellation refunds after December 31. Thank you for registering for Midwinter 2019!
