General Waiver
For all guests attending a Manderley Retreat/Camp Event.
Contact Information
Camper/Guest Name
*
First Name
Last Name
Camper/Guest Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Camper/Guest Email
*
example@example.com
Camper/Guest Phone
*
Please enter a valid phone number.
Is Camper aged 21 or older?
Yes
No
Date of Birth
-
Month
-
Day
Year
Date
Gender
Male
Female
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Visit Information
Group Name
*
Please Select
FBC Chickamauga
Raid on Manderley
Reformed BC
Name of your church or school
Arrival Date
*
-
Month
-
Day
Year
Date
Departure Date
*
-
Month
-
Day
Year
Date
Any Food Allergies?
*
Yes
No
List Food Allergies
Doctor Note
*
Browse Files
Drag and drop files here
Choose a file
Please upload a doctor's note stating the allergen(s)
Cancel
of
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Emergency Contact
EC Name
*
First Name
Last Name
EC Phone
*
Please enter a valid phone number.
EC Relationship
Mother, Father, Spouse, etc.
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Minor Information
Please complete in full and to the best of your knowledge
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone
*
Please enter a valid phone number.
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Liability & Indemnity
Guest Signature
*
Legal Name
*
First Name
Last Name
Parent/Guardian Signature 1
*
Parent/Guardian Name 1
*
First Name
Last Name
Parent/Guardian Signature 2
*
Parent/Guardian Signature 2
First Name
Last Name
Submit
Should be Empty: