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Waterloo Village Retreat Registration for 3/10/18
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First name:
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Your answer
Last name:
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Your answer
Address:
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Your answer
Phone number:
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Email address:
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Emergency contact name and phone number:
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Have you been to a Waterloo Village retreat before?
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How did you hear about the retreat?
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As in any activity, there are inherent risks and injuries that may occur. I agree that I am physically sound to participate. I hereby release and discharge Tim Nicinski, Laura Murphy, Waterloo United Methodist Church and JAM Catering from any and all actions for losses, damages, or personal injuries to myself which may occur or arise out of my participation in this activity (Please type yes or no and initial)
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