Deep Woods Immersion Registration
Interested in participating in a Deep Woods Immersion retreat? Please fill out this registration form. Contact Dennis Fulkerson at 319-573-6331 or dennis@mvcbc.org with questions. Deep Woods Immersion is a ministry of Mt. Vernon Community Bible Church.
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Deep Woods Immersion is open to adult men 18 years of age or older, or high school boys attending with their fathers/guardians. Please confirm that you meet this requirement. *
Which DWI weekend would you like to attend? *
Your name *
Email address *
Phone number *
Home address *
Have you read the DWI retreat information sheet? (Link) *
It is important to be present for the full DWI experience for you and for the other men. You agree to arrive at 4pm on Friday and stay through the end of the retreat on Sunday morning.
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DWI is a guided retreat. You agree to willingly submit yourself to the guidance and leadership of DWI staff men.
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DWI includes long periods of silence and solitude. You agree to participate in and respect DWI’s silence and solitude requirements for yourself and for the other men on the retreat.
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Cell phones and electronics (tablets, computers, mp3 players, smart watches, etc.) are a hindrance to the DWI experience. You agree to allow DWI staff to hold your cell phone during the retreat. You will be given a daily opportunity to call home if desired. You also agree to refrain from bringing other electronic devices or musical instruments.
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While DWI is not intended to be a rigorous physical experience, men must be physically able to hike several miles through the woods, stay in primitive cabins or tents, remain outdoors much of the time, be exposed to variable weather conditions, and use pit toilets. You agree that you are able and willing to do so.
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The importance of food is deemphasized during the DWI experience. Meals and snacks will be provided, but will largely consist of simple, convenient, easily prepared, and/or prepackaged items. Beverages will be limited to water and coffee. You may bring your own snacks and drinks (non-alcoholic) as desired.
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The cost of DWI is $100. You agree to pay this amount (cash/check - payable to Community Bible Church) when you arrive at the retreat location.
 *
Depending on retreat location, some DWI retreats require staying in tents.  *

Please read and sign the following waiver:

You agree to willingly and voluntarily participate in Deep Woods Immersion (DWI) retreat completely at your own risk. DWI, DWI staff, Community Bible Church, the host facility, and affiliated individuals and organizations are not responsible for discomfort, disappointment, damages, injury, dismemberment, sickness, death, loss, or any other negative outcomes experienced during or resulting from the DWI retreat. You agree to hold DWI, DWI staff, Community Bible Church, the host facility, and affiliated individuals and organizations harmless for any negative outcomes that may occur during or as a result of DWI retreat experience. Any losses incurred as the result of the DWI retreat experience are the sole responsibility of you, the DWI retreat participant.

I, the undersigned, agree to this waiver statement. (Type your name below. Your typed name represents your legal signature.)

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Why are you interested in participating in a DWI retreat? *
What are you hoping to get out of your DWI retreat experience? *
Do you have medical insurance? If so, who is your insurance provider? *
Do you have any health issues or concerns that DWI staff need to be aware of? If so, please explain. *
Do you have any medical or physical conditions that would limit your DWI experience? If so, please explain. *
Do you take prescription medication? If so, what medication for what condition? *
Do you have any food allergies or dietary restrictions? If so, please explain. *
Do you have any other known allergies (bee stings, spider bites, hay fever, etc.)? If so, please explain. *
Is there anything else that you think DWI staff should know about you or your situation?
Please give an emergency contact name and phone number. *
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