2022 Teen Retreat Registration

Your Contact Information

Teen Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Teen's Cell Phone

Text Reminder and Event Notices

I would like BDFNC to send me a text reminder before this event.
I would like to receive text messages about upcoming BDFNC events.

Teen's Email

BDFNC will contact you at this address to confirm your registration request.

Teen's Date of Birth *

Teen's Bleeding Disorder (if any)

Parent/Guardian Name *

Parent/Guardian Cell Phone *

Parent/Guardian Email *

Persons Attending

Are You Bringing Other Teens With You? *

Yes
No

They will also need to register

What is their name? *

Photography Permission

Do you give Bleeding Disorders Foundation of North Carolina permission to use photographs and videos of you and your party, taken at this event, in its printed and electronic publications? *

Yes
No

Mask Policy Agreement

Mask Policy Agreement *

I agree that all members of my party ages two and older will wear a mask and maintain a safe distance from other families

Attendance Policy Agreement and Waiver

BDFNC Event Registration and Attendance Policy *

I you have read and agree to abide by the BDFNC Event Registration and Attendance Policy.

Click here to view the full policy statement

Indemnification Waiver *

I above agree to waive all claims against BDFNC on account of any accident, injury, and/or illness that may occur during or as a result of attending this event.

Click here to view the full waiver statement

Comments

Please indicate any special dietary or other accommodations needed.

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