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Silver Birch Ranch Visitor Form
1
Name
*
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First Name
Last Name
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2
Phone Number
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Area Code
Phone Number
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3
E-mail
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4
Are you currently at least 18 years old?
*
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YES
NO
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5
I am the invited guest of:
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First Name
Last Name
Their Title/Position
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6
Purpose of your visit.
*
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Please write a brief description of why you are visiting SBR.
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7
I plan to arrive on:
*
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Minutes
AM
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8
I plan to depart on:
*
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-
Date
Month
Day
Year
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Minutes
AM
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PM
AM
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9
Will you be eating camp meals?
*
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($5.00 for each meal)
YES
NO
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10
If available, I would like to attend the following meals and will pay $7.00 for each meal (due at check-in):
Breakfast
Lunch
Dinner
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11
Please select any allergies that apply to you or those who are in your care that will be visiting with you:
NOTICE: We only provide food alternatives for the allergies listed below.
None
Gluten
Celiac
Dairy
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12
If available, I would like to stay in Silver Birch Ranch housing during my stay for the cost of $10 per person per night:
*
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YES
NO
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13
Visitor Release Form
*
This field is required.
Silver Birch Ranch is committed to the safety and well-being of everyone who is involved in any aspect of our ministry. From time to time events may occur where medical care or treatment is necessary for an individual while they are involved in this ministry.
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14
Emergency Contact
*
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First Name
Last Name
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15
Emergency Contact Phone Number
*
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Area Code
Phone Number
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16
List family members and/or those in your care who will be staying with you (if applicable):
NOTE: If family a member is 18 or older, they must fill out this form separately.
Full name
Relationship
Full name
Relationship
Full name
Relationship
Full name
Relationship
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17
Digital Signature
*
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First Name
Last Name
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Silver Birch Ranch Visitor Form
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