MWP Use of Amenities Form

MY WARRIOR'S PLACE & ITS PROGRAMS

USE OF AMENITIES at the MWP Retreat Center property located at 3269 Duncan Road, Punta Gorda, FL 33982. (Minimum of a 24-hour notice required) unless you are going to fish off docks and/or use your own vessels and equipment.
Name (First & Last):*
Email:*
example@example.com
Phone Number:*
Include area code
Phone number is:*

CellHome
Date coming:*

MonthDayYear
Date
Time you will be coming:*

:HourMinutesAM/PM Option
I am coming by myself:*

YESNo
If no, how many guests will be coming?
I will be coming on date provided above to (Check all that apply):*

Use Kayak/Canoe(s)Use my own vesselsUse of Docks to FishUse my own Fishing Equip.Use of Fishing EquipmentUse of Fire PitUse of other amenities
If coming to use the canoes and/or kayaks how much experience do you have?*

Little or No experienceModerately skilledExpert very skilled
Has everyone that is coming already signed a waiver?*

YESNONo, but will be by time of arrival
Have you been vetted by the office for your service? (proof of service)*

YESNONo, but will do it before or on day of arrivalYes, but I have lost my card
Any additional information you may want to share if you have lost your card:
*Note: Everyone must have a waiver submitted. Once submitted the waiver is only good until the end of the year (December 31). A new waiver will need to be submitted each calendar year.
I am a (Check all that apply):

Military Service MemberLaw Enforcement OfficerFirefighterVeteranLaw Enforcement (Retired)Firefighter (Retired)Blue Star Family MemberLEO Family MemberFirefighter Family MemberGold Star Family MemberSilver Star Family MemberWhite Star Family MemberEMT (active)EMT (retired)EMT (Family Member)
Please inform us of any condition (medical or physical) that we need to know about for your safety or the safety of any minor children you may be bringing with you to MWP.
*Note: If you will be using any of MWP's vessels, fishing equipment or other items, it is very important to contact us immediately if you are not coming or you are not arriving at the time you stated so our volunteer is not kept waiting for you to arrive.
Date Submitted

MonthDayYear
My Warrior's Place and all of our Programs appreciates the sacrifice and service made by all of our American Heroes and their families.
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MY WARRIOR'S PLACE & ITS PROGRAMS