Register for Teen Retreat Event *Fall Teen Retreat: November 19 – 21, 2021Spring Teen Retreat: April 1 – 3,2022Name *Gender *MaleFemaleAge *Date of Birth *Month *Day *Year *Email Address *Street Address *Apartment, suite, etcCity *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 ShotDo you have insurance? *YesNoInsurance Provider *Name of Policy Holder *Policy Number *Are you Current on Immunizations? *YesNoDietary NeedsAlergiesMedicationsDo you have any of the following? *YesNoSleepwalk, Faint, Epilepsy, Diabetes, AsthmaDo you Sleepwalk *YesNoDo you Faint *YesNoDo you have Epilepsy *YesNoDo you have Diabetes *YesNoDo you have Asthma *YesNoPre Existing Medical ConditionsOther Important InformationHow do you plan to pay?OnlineMailWhen you arrivePermission 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 AgreeType Name as Signature *Parent or Guardian of under 18SubmitPlease do not fill in this field.