Wind Dance Farm and Earth Education Center
Women's Wilderness Retreat
June 6th, 7th & 8th, 2025
Participant Name
Address
Phone
Alternate Phone
Email
Emergency Contact
Emergency Contact Phone #
Dietary Restrictions
Vegetarian
Vegan
Gluten Free
None
Other:
Accomodations
Clear choice
Offsite
Onsite
Medical Information
Do you have any allergies, chronic illness, or medical conditions? If yes, please describe.
Permissions
Do you give permission to use photos for articles, social media and website?
Yes
No
Please provide us with any thoughts or concerns you have about attending. If you have a skill you would like to share, please let us know about that too!
We would love to know how you heard about Wind Dance!
Payment
A non-refundable deposit is due to complete registration. Payments can be made by cash, check or sent via paypal.
Pay pal address is:
wind.dance@frontier.com
Please make checks payable to
Wind Dance Farm & EEC
100 Wind Dance Trail, Berkeley Springs, WV 25411
Payment options
Non-Refundable Retreat Deposit $100
Pay in Full $275 Offsite
Pay in Full $325 Onsite
Waiver and Release Form and
Medical Consent
I agree to release and hold harmless Wind Dance Farm & Earth Education Center, its officers, agents, employees, and volunteers for any and all claims, demands, costs, and expenses, including reasonable attorney’s fees that Wind Dance Farm & Earth Education Center may suffer as a result of any claim, action, demand, or judgment against it arising from the attendance at camp by this applicant and/or family members.This release is intended to discharge in advance Wind Dance Farm & Earth Education Center, its officers, employees, agents, and volunteers from liability. It is understood that some camp activities involve an element of risk of accidents, and knowing the risks, I hereby assume those risks. It is further understood and agreed that this waiver, release, and assumption of risk is to be binding on my heirs and assignees. I agree to release Wind Dance Farm & Earth Education Center from any and all liabilities.
Consent for Treatment
I hereby give my consent to have the above applicant treated by emergency medical personnel, a physician, or surgeon, in case of sudden illness or injury while participating in the above activity. It is understood that Wind Dance Farm & Earth Education Center will provide no medial insurance for such treatment and that the cost thereof will be at my expense. I have read and understood the foregoing liability release and parental consent form and agree to all of its terms and conditions.
Confirmation
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature
Clear
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