Mail In Registration - edge of the water

Name

First

Last

Email

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Church (optional)

Lodging choice

Lodge – $150.00
Private Room (limited; first come first served) – $180.00
Day Pass ( Not sleeping on grounds) – $80.00

Cottage

I am willing to sleep in a Cottage

Bed choice, check all that apply

Are you willing to Share a Bed with anyone?

I would like to room with or share a bed with…

Friends or family, you would like to share a room with.

Dietary or Special needs

What do we need to know to make this retreat fit your needs? Allergies, Disabilities, Mobilities problems, etc.

Photograph Consent. Please select and sign below

I Grant Permission to be photographed
I Do Not Grant Permission to be photographed
As the parent of a minor child I grant permission for them to be photographed
As the parent of a minor child I do not grant permission for them to be photograped

*Here at retreat we enjoy celebrating and sharing our time with others. As a result your photos might be taken and might be displayed on our Facebook, Instagram, and or website.

Signature

Clear Signature

*By signing this form I agree to my choice above for Edge of the Water Women’s Retreat to take or not to take and use or not to use photographs and/or digital imaging of myself (or my Child underage of 18) for use in printable publications and material, electronic publications, website, Facebook, Instagram, and Edge of the Water Retreat scrapbook for the duration of the retreat now and for future retreats until I give a written notice of complaint to edgeofthewaterretreat@gmail.com as well as the picture used.

Emergency Information. Below list any Heath concerns that the commitee should be aware of.

Emergency contact #1

FIRST AND LAST NAME

Emergency Contact #1 Phone Number

Emergency Contact #2

FIRST AND LAST NAME

Emergency Contact #2 Phone Number

Emergency Information Signature

Clear Signature

ALL ABOVE INFORMATION WAS GIVEN VOLUNTARILY I hold the Edge of the Water Women’s Retreat HARMLESS of any LEGAL LIABILITY In case of a medical emergency, guests’ personal insurance would be responsible for all expenses.

Steams (pick only one this year)

Total

$0.00

Signature

Clear Signature

By signing this form, I agree to mail in the total amount due before September 2025. I understand that some selections have first come first serve and I am not guaranteed these choices. Mail to: Edge of the Water Retreat 1805 7th Street, Maumee, OH 43537