Complete Registration Forms Thank you for registering for this Rites of Passage Council program. Please complete the following forms: Registration Information Basic information for Vision Quest and Training Program participants Contact InformationProgram for which you are registeredJuly 2022: Women's 5 Day Ritual ~ AshevilleJuly 2022: Year Long Training Program 2021-2022July 2022: Grief Ritual ~ AshevilleAugust 2022: Vision Quest ~ AshevilleSeptember 2022: Womens Forest Prayer Fast ~ AshevilleOctober 2022: Men's Encampment ~ AshevilleNovember 2022: Road AheadName First Last Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of birth* Emergency ContactsEmergency Contact* First Last Relationship to you?* Their Phone Number*Doctor's Name First Last Your Doctor's Phone NumberDietary InformationDietary Preferences I eat everything including animal products. Vegetarian. Indicate any specific allergies here: Severe allergy to nuts Severe allergy to soy Severe allergy to dairy Severe allergy to gluten I have no food allergies If you have no allergies, indicate by choosing that option.List any other food allergies here: Confidential Health InformationDo you wear a Medic Alert Tag? yes no Have you ever had a heart attack of any kind? yes no Have you ever been told by a doctor that you have high blood pressure, heart murmur, or heart disease? yes no Do you experience anaphylactic shock form insect stings? yes no Have you ever experienced a seizure of any kind? yes no Do you have allergic reactions to any environmental substances, foods or drugs? yes no Do you have hemophilia? yes no Have you ever had lung disease? yes no Do you have any disabilities of back, hips, knees, ankles, or other joints? yes no If you walked on level ground for a mile at an average pace would you get out of breath, have pains in the chest or legs or develop muscle fatigue? yes no Are you taking any medications or herbal supplements currently or within the past year? yes no Do you have Hypoglycemia? yes no Do you have Diabetes? yes no Are there any reasons why you should not fast or camp alone? yes no If you are under the care of a physician would she/he disapprove of your entering this activity? yes no List here allergic reactions, medications and any other important health information we need: Is there any other medical information we should have regarding health conditions that may affect your participation in this program? 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