Activity Waiver Form
For all guests attending a Manderley Retreat/Camp Event.
Contact Information
Camper/Guest Name
*
First Name
Last Name
Camper/Guest Email
*
example@example.com
Camper/Guest Phone
*
Please enter a valid phone number.
Camper/Guest Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Next
Visit Information
Group Name
*
Please Select
Bethlehem Baptist Youth
Calvary Church
Calvary Red Bank
Chi Alpha Leadership
Chi Alpha TN Tech
Chi Alpha UTK
Church Safety Retreat
Clear Creek C of C
Collegeside
Crossroads
Eastwood FB Ladies
Fall into Quilting
FBC McMinnville Kids
FBC McMinnville Teens
Grace Bible Church
Grace Community Family
Lifepoint Church High School
New Union Teens
Spring Into Quilting
Tabernacle CS
Westwood COC
Wild at Heart
Woodland Park
Name of your church or school
Arrival Date
*
-
Month
-
Day
Year
Date
Departure Date
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
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.
Is Guest aged 17 or younger
*
Please Select
Yes
No
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Minor Information
Please complete in full and to the best of your knowledge
Camper Birthdate
*
-
Month
-
Day
Year
Date
Camper Age
*
Please Select
17
16
15
14
13
12
11
10
9
8
7
6
5
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone
*
Please enter a valid phone number.
Parent/Guardian Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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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: