Register for Teen Retreat – Bible Impact Ministries

Event *

Spring Teen Retreat: April 12 – 14, 2024

Name *

Gender *MaleFemale

Age *

Date of Birth *

Month *

Day *

Year *

Email Address *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Phone *

Parent / Guardian *

Emergency Contact Name *

Emergency Contact Phone *

Relationship of Emergency Contact *

Pickup Person *

Church *

Date of Last Tetanus Shot

Do you have insurance? *YesNo

Insurance Provider *

Name of Policy Holder *

Policy Number *

Are you Current on Immunizations? *YesNo

Dietary NeedsWWBC kitchen provides a variety of options every meal to accommodate for different tastes, preferences, and diets. The kitchen also uses a variety of known allergens (nuts, milk, eggs, wheat, etc.) that may come into contact with your food. Since allergens are present in the kitchen and cross contamination can easily occur, we cannot guarantee an allergen-free environment. Please list above any medically necessary dietary needs so that the kitchen can best determine how to accommodate for them. If you would like to discuss this further, or have questions, please contact us directly at kitchen@bibleimpact.org

Alergies

Medications

Do you have any of the following? *YesNoSleepwalk, Faint, Epilepsy, Diabetes, Asthma

Do you Sleepwalk *YesNo

Do you Faint *YesNo

Do you have Epilepsy *YesNo

Do you have Diabetes *YesNo

Do you have Asthma *YesNo

Pre Existing Medical Conditions

Other Important Information

How do you plan to pay?

OnlineMailWhen you arrive

Permission Statement – By clicking submit below, I GIVE PERMISSION for Whispering Winds Bible Camp (WWBC) to secure medical treatment for myself, my spouse, or my child in case of illness or accident. I GIVE PERMISSION for my child to participate in all Camp activities, both on and off camp property, either by walking or riding in camp vehicles, including (without limitation): hiking, backpacking, canoeing, kayaking, caving, water tubing, low ropes course, climbing wall and swimming. I ACKNOWLEDGE AND ACCEPT the risks involved in camping activities for myself, my spouse, or my child. I ACCEPT personal financial responsibility for any bodily injury sustained by myself, my spouse, or my child while at WWBC. Furthermore, I PROMISE to hold harmless WWBC and its representatives for any injury related to Camp. I GIVE PERMSSION for my child to receive Bible-based instruction while at WWBC. I AGREE for myself, my spouse, and my child to abide by the dress standards and rules of conduct of WWBC. I GIVE PERMISSION for WWBC to use pictures including myself, my spouse, or my child in organizational publicity. *

I Agree

Type Name as Signature *Parent or Guardian of under 18