Register for Winter Retreat
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Event
Camper's Full Name
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Camper's Gender
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Camper's Date of Birth
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MM
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DD
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Age as of Event *
Email Address
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Street Address
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Apartment/Suite/etc.
City
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State/Province
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ZIP/Postal Code
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Phone
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Parent/Guardian Name
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Emergency Contact Name
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Emergency Contact Phone
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Relationship of Emergency Contact
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Pickup Person
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Church
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Date of Last Tetanus Shot
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MM
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DD
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YYYY
Do you have insurance?
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Are you current on immunizations?
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Please list any dietary needs you have
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Please list any allergies you have
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Please list any medications you take
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Do you have or experience any of the following: Sleepwalking, fainting, epilepsy, diabetes or asthma
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Do you have any other pre-existing medical conditions?
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Do you have any other important information to share?
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How do you plan to pay?
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Permission Statement - By completing and submitting this form, I GIVE PERMISSION for Whispering Winds Bible Camp (WWBC) to secure medical treatment for the participant in case of illness or accident. I GIVE PERMISSION for my child to participate in all activities, at this event. I ACKNOWLEDGE AND ACCEPT the risks involved in camp activities. I ACCEPT personal financial responsibility for any bodily injury sustained while my child is at WWBC's event. Furthermore, I PROMISE to hold harmless WWBC and its representatives for any injury related to this event. I GIVE PERMSSION for my child to attend this event and receive the Bible-based instruction provided. I GIVE PERMISSION to use pictures including the participant in organizational publicity. * *
Type name as your signature - have a parent or guardian sign if you are under 18
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