Women's Retreat Registration Form
Name of Participant *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Mailing Address *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
T-shirt Size *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Do you have any allergies or medical conditions that staff should be aware of? *
If yes, please list information regarding allergies and/or medical conditions of which staff/volunteers should be aware.
Your answer
In an emergency, I grant permission for emergency medical treatment to be administered. I agree to pay all medical bills not covered by my insurance company listed below. I release Volley for Christ and its staff and volunteers from responsibility for any bills resulting from injuries incurred in this program. While no sports physical is required to participate, I understand that good physical condition and current medical exam is strongly recommended. I have listed information regarding allergies and/or medical conditions of which staff/volunteers should be aware. *
I give permission to be photographed and for such photographs to be released for publicity purposes. *
Insurance Company *
Your answer
Policy Number *
Your answer
Electronic Signature of Participant *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms