Here’s a sample Neftaly Registration Form that you can use to capture participant details and confirm their enrollment in the camp:
Neftaly Camp Registration Form
Thank you for your interest in the Neftaly Health and Wellness Camp! Please fill out the form below to complete your registration.
Personal Information:
- Full Name
[ ] First Name: ___________
[ ] Last Name: ___________ - Date of Birth
[ ] MM/DD/YYYY: ___________ - Gender
[ ] Male
[ ] Female
[ ] Non-Binary
[ ] Prefer not to say
[ ] Other: _______________ - Contact Information
[ ] Phone Number: ___________
[ ] Email Address: ___________ - Emergency Contact Information
[ ] Emergency Contact Name: ___________
[ ] Emergency Contact Phone: ___________
[ ] Emergency Contact Relationship: ___________
Health and Wellness Information:
- Do you have any medical conditions or allergies we should be aware of?
[ ] Yes (Please specify): _______________
[ ] No - Are you currently on any medication?
[ ] Yes (Please list): _______________
[ ] No - Do you have any dietary restrictions or preferences?
[ ] Vegetarian
[ ] Vegan
[ ] Gluten-Free
[ ] Dairy-Free
[ ] Other: _______________
[ ] No restrictions
Camp Enrollment Information:
- Which camp dates are you enrolling for?
[ ] January 2025
[ ] February 2025
[ ] March 2025
[ ] Other: _______________ - Have you attended a wellness or health camp before?
[ ] Yes
[ ] No - What are your primary goals for attending the Neftaly Health and Wellness Camp? (Please select all that apply)
[ ] Improving physical fitness
[ ] Learning about healthy eating and nutrition
[ ] Reducing stress and improving mental health
[ ] Learning mindfulness and meditation techniques
[ ] Building healthier lifestyle habits
[ ] Other: _______________
Consent and Acknowledgment:
- Emergency Medical Authorization
I hereby give permission to the camp organizers and facilitators to seek medical treatment if necessary during my participation in the camp.
[ ] I Agree
[ ] I Disagree - Liability Waiver
I acknowledge that my participation in the camp is voluntary and that I am responsible for my health and well-being during the camp. I release Neftaly from any liability related to my participation.
[ ] I Agree
[ ] I Disagree - Photograph/Video Release
I consent to the use of photographs or videos of me taken during the camp for promotional purposes.
[ ] I Agree
[ ] I Disagree
Payment Information:
- Camp Fee:
[ ] $_______ (Please fill in the appropriate fee for the camp session)
Payment Method:
[ ] Credit Card
[ ] PayPal
[ ] Bank Transfer
[ ] Other: _______________
Confirmation:
- Please confirm your enrollment:
[ ] I confirm that all the information provided is accurate and complete. I understand the terms and conditions, and I am ready to participate in the camp.
Submit your registration by clicking the button below:
[ Submit Registration ]
This form ensures all necessary participant information is captured, as well as any consent or acknowledgment needed for participation in the camp. You can modify and adapt the form depending on the specifics of your camp and any additional data you might need.
