Wilderness First Responder – 5 Day Wilderness First Responder (WFR) is the definitive course in medical training for outdoor educators, guides, SAR team members, and others who work or play in remote areas. The curriculum is comprehensive and practical, including all of the essential principles and skills required to assess and manage medical problems in isolated and extreme environments. The 5-day format is for individuals with less time available for on-site training and requires 25+ hours of pre-course preparation.The Dates You Would Like To Attend*February 16th - 20th 2019February 22nd - 26th 2019 (Scottsdale, AZ)March 13th - 17th 2019April 27th - May 1st 2019May 15th - 19th 2019June 15th - 19th 2019Student InformationName* First Last Email* Enter Email Confirm Email Mailing Address For Textbook (shipping via USPS)* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*How Did You Hear About Us?*Our WebsiteWMAAMGASearch EngineReferralI'm a former studentFacebookInstagramTwitterOtherEmergency ContactEmergency Contact Name* First Last Relationship*Emergency Phone*Emergency Email* Enter Email Confirm Email Personal InformationT-Shirt Size - Unisex* Extra Small Small Medium Large X Large 2X Large Height (ft)*3'4'5'6'7'Height (in)*0"1"2"3"4"5"6"7"8"9"10"11"Weight (lbs)*Age*Parent/Guardian Name* First Last Parent/Guardian Email* Medical InformationWilderness Leadership Institute (WLI) requests this information to assist staff in the management of courses and in the emergency response of medical conditions that any participant or observer may have. This information will remain protected and confidential. By requesting this information, WLI does not imply that we have the expertise to assess your physical condition or your ability to participate in this course. This determination of ability must be made by you, the participant, in concert with your physician.Please list any relevant medical or psychological conditions that you are currently managing or have had in your past (Enter 'None' if not applicable)*Note: The following list is a non-exhaustive list of conditions that may be pertinent: musculoskeletal injuries, cardio-respiratory system problems, neurologic conditions, allergies (environmental, food, etc.), blood sugar management, heat or cold injury…Please list any medications that you take on a regular or periodic basis, and the typical dosage (Enter 'None' if not applicable)*I understand and acknowledge that Wilderness Leadership Institute is not making a determination of my fitness for a course; rather, I represent to Wilderness Leadership Institute and verify that I am physically fit and ready for the course. I have read and agree to the terms of the "Consent to Treat & Full Disclosure Statement" and the "Cancellation & Refund Policy".* Confirm Download the Consent to Treat & Full Disclosure Statement and Cancellation & Refund Policy forms.Course InformationPrevious Medical Traing (Check all that apply)* None Basic CPR Basic First Aid WFA WAFA WFR EMT WEMT Paramedic Nurse Doctor Will you be camping on-site?*Yes, I will be camping on-site.No, I have other accommodations.The cost to camp on site is $15 per person, per night. Camping fees will be collected on the first day of class. Camping is available starting the day before the course starts. Students staying on-site will have access to the classroom, full kitchen, and bathrooms with showers. There are no pets allowed on-site.Number of Nights Camping*123456789Number of People Camping*123456789Payment Options*5 Day WFR - $699.005 Day WFR (Scottsdale, AZ) - $749.00Total $0.00 Supported Credit Cards* MasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Billing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code You will be redirected to sign a waiver following the completion of this form. Please review and digitally sign to complete your registration. EmailThis field is for validation purposes and should be left unchanged.