Winter Minicamp Adult Registration

Adult Registration for CISV Winter Minicamp

Please fill in the form below.
Intended use: This form shall be used for adults attending CISV USA activities held within the United States (mini camps, Annual Meeting & Conference/CISV In Motion, National Youth Meeting, National Leadership Training, etc.)
This form is to be completed by the adult participant. Completion and signing of this form is a condition of participation in the CISV activity named below.

Event: CISV JB Jax Winter Minicamp

Date: President's Day Weekend from Friday night to Monday morning

Event Address: Camp St. John at Marywood Retreat Center 235 Marywood Drive St. Johns, FL 32259
Full Name of Adult Participant *

First Name Last Name
Gender Identity *

Male Female Other
Date of Birth of Participant *

Month Day Year
Date
Phone Number of Participant

Area Code Phone Number
E-mail of Adult Participant
List any dietary restrictions
List any allergies or other health restrictions
Are you fully vaccinated for Covid-19?

Yes No
Upload vaccine card

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Cancel of
Part 2: Emergency Contact Info

Please provide a contact that CISV can use during the activity in the event of a medical or other emergency:
Name of Emergency Contact *

First Name Last Name
Address of Emergency Contact

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Emergency Contact Phone Number *

Area Code #1
Emergency Contact Email
example@example.com
Name of Alternate Emergency Contact

First Name Last Name
Phone of Alternate Emergency Contact

Area Code Phone Number
Which CISV Chapter *
T-shirt size of Participant *

Adult Registration for CISV Winter Minicamp

Part 2: Emergency Contact Info

Part 3: Authorization for Medical Treatment

Part 4: Medical Insurance &Financial Responsibility for Medical Treatment

Part 5: Legal Release & Responsibility to Pay for Damages

Part 6: Membership

Part 7: Permission to Use Photographs, Art or Written Work

National Code of Conduct for Junior Branch USA