Event *
Name *
Mailing Address *
City *
State *
Zip *
Phone *
E-mail Address *
Preferred Shirt Size: For multi-course workshop only.

Medical History
All information is confidential and will only be released in the event of a medical emergency.
Date if Birth *
Physician *
Physician's Phone # *
Emergency Contact Name *
Phone # *
Relationship *
Are you allergic to any medication (Penicillin, Aspirin, etc.)? *	Yes No
List
Do you take any medication critical to your health? *	Yes No
List
Have you ever been told by a doctor that you have epilepsy? *	Yes No
When?
Have you had recent surgical operations, accidents or injuries? *	Yes No
When/What?
Have you been knocked unconscious, had a concussion or head injury? *	Yes No
When?
Are you Pregnant? *	Yes No
Expected Delivery Date
Do you wear glasses *	Yes No
Do you wear contact lenses *	Yes No
Date of last tetanus immunization *
Please check any of the following medical conditions you have had within the last five years:	Heart Disease Diabetes Fainting Spells High Blood Pressure Asthma Seizures Hay Fever or Allergies (especially bees, ants, etc.)
List all Allergies
Do you have any medical training?	Doctor EMT Nurse
Other Training (Please Specify)
Is there anything else about your health you would like known in case of an emergency? *
.... *	I CERTIFY THAT THE ABOVE IS TRUE

Emergency Medical Authorization
The attached health history questionnaire is correct to the best of my knowledge, and I am able to engage in all activities, except as noted by me and a physician. In the event of an emergency, I hereby give permission to a physician to hospitalize, secure proper anesthesia, or to order injection or surgery, or other medical procedures required by the emergency situation
I give consent for the staff of Becoming an Outdoors-Woman, California (hereinafter BOW California) to provide medical attention, transportation, and emergency medical services as warranted by the circumstances.
I represent that I am in good physical condition, and I am not aware of any disease or injury that would be aggravated or result in my being incapacitated or injured during any program participation, except as designated herein.
.... *	I CERTIFY THAT THE ABOVE IS TRUE

Liability Release
If I am injured, or suffer any illness or disease while residing at and participating in programs of BOW California, I agree to hold BOW California harmless for any said injury, illness, or disease.
I further understand and agree to abide by the general rules of conduct prescribed for guests, and understand that violations will result in a denial of privileges, a forfeiture of all fees paid, and immediate removal from the grounds where the program is being conducted.
I have read this release, and I understand it affects my legal rights and responsibilities. I hereby agree and consent to its terms and conditions and waive any claims arising while residing/participating in programs of BOW California.
.... *	I CERTIFY THAT THE ABOVE IS TRUE

Cancellation Policy
If you cancel three weeks or less prior to the workshop date, you will forfeit 100% of your registration unless you provide a replacement, or someone on the waiting list accepts your spot.
I have read and understand the Cancellation Policy.
.... *	I CERTIFY THAT THE ABOVE IS TRUE

EVENTS	Multi-Course Workshop ($395) Multi-Course Workshop 10% off w/friend($355.50) Cross-Country Skiing ($325) Birding ($225) Personal Self-Defense ($200) BOW Fundraiser_ One Person ($100) BOW Fundraiser_ Two People ($175) Drawing on Nature ($250) Hiking Pole Field Seminar ($45) Geocaching and Outdoor Cooking ($225) A Day at the Range ($110) Map, Compass and GPS ($125) Fly Fishing_ Tejon Ranch ($250) Soapstone Carving and Bird Watching ($200) Fly Fishing_ Bidwell Ranch ($250) Pheasant Hunt ($100) Total :

Your spot will not be reserved until you have finished the entire registration process including payment.