Registration Form

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RETREATS

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E-mail Address: *

Last Name *

First Name *

Birthday (mm/dd/yyyy) *

Mailing Address *

City *

State *

Zip Code *

Cell Phone # *

Home Phone #

Spouse

Contact Phone #

Church Name

Church Phone #

Any medical conditions we need to be aware of

Medications - in case of an emergency

Emergency Contact Name *

Emergency Phone # *

Physican's Name *

Physican's Phone # *

Other info we might need to be aware of

Liabilities Release: I hereby release, discharge, and agree to indemnify and hold harmless The Godly Girlfriends’ Retreats, the camp facility, staff, all sponsoring organizations, and their directors, officers, employees, agents, and volunteers from any responsibility, liability, personal and otherwise, claims, loss, or damage arising out of and/or alleged to arise out of my participation. *

* Required