General Waiver
For all guests attending a Manderley Retreat/Camp Event. If you have issues completing this form, please try using another web browser such as Chrome, etc.
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.
Format: (000) 000-0000.
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
Bethlehem Baptist Men
Bible BC
Bledsoe Co High Soccer
Calvary Church Teens
Carolyn Culver Family
Cornerstone Baptist Church
Crossroads Community Church
Fall into Quilting
FBC Chickamauga
FBC McMinnville Kids
FBC McMinnville Teens
FBC Pikeville
Goodlettsville Pentecostal Teens
Grace Community Church
Hope for Ukraine
Johnson Ferry
Lifepoint Church
Midsouth Christian Leadership
Ms Nell's Camp Courageous
Prayer Walk
Raid on Manderley
Reformed BC
Spring into Quilting
West Huntsville
Wild at Heart
Woodland Park Baptist Church
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.
Format: (000) 000-0000.
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.
Format: (000) 000-0000.
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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: