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E-mail Address:
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Last Name
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First Name
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Birthday (mm/dd/yyyy)
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Mailing Address
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City
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State
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Zip Code
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Cell Phone #
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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
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Emergency Phone #
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Physican's Name
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Physican's Phone #
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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.
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Nathalie Kelley