Teen Retreat Registration

Gender *
Date of Birth *
Date of Birth
Address *
Phone *
Meal Preference *
Shirt Size *
Please: all sizes are adult sizes.
Please list any allergies, medical concerns, medications, etc. If none, please write N/A.
Emergency Information
Emergency Contact *
Emergency Contact
Must be over 25 years of age.
Relation to Participant *
Phone *
Insurance Information
All insurance information will be kept stricly confidential.
Medical Action Consent *
By checking the box below, I agree that If any of the persons listed in this form become ill or incapacitated, I grant Camp Sikh Virsa or its volunteers full authority to take whatever action they feel is warranted under the circumstances in regard to their health and safety, including securing medical treatment (at my expense). I further release any of these persons from any liability for such decisions or actions that may be taken on my behalf.
Please list 2-3 topics. The more detail the better.
If there is any information that you would like us to know, please include that here. If you would not be at the retreat for the full time, or have certain travel arrangements or other concerns, you can share that here, as well.