Pay Online 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 – $155.00
Private Room (limited; first come first served) – $185.00
Day Pass ( Not sleeping on grounds) – $85.00

Credit card companies charge us a percentage for every dollar processed through a credit card. This convenience fee is a percentage of the whole total. Adding $5 to the total registration cost helps the retreat from their extra charge for processing the card and helps offset those expenses. This $5 does not cover the whole percentage that the retreat will be charged; but helps offset the charge to the retreat. We gladly accept payments via cash or checks, which do not carry this fee. If you do not want to pay this charge, go back to the registration page and click “mail in registration”. Fill out the mail in registration form and mail a check to the address provided. Your comprehension and collaboration are sincerely valued, and we are dedicated to delivering the utmost quality service to you.

Cottage

I would be interested to sleep in a Cottage

Bed choice, check all that apply

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.

Photo Consent

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

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

Emergency contact #1

First

Last

Emergency Contact #1 Phone Number

Emergency Contact #2

First

Last

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

Total

$0.00

Credit card companies charge us a percentage for every dollar processed through a credit card. This convenience fee is a percentage of the whole total. Adding $5 to the total registration cost helps the retreat from their extra charge for processing the card and helps offset those expenses. This $5 does not cover the whole percentage that the retreat will be charged; but helps offset the charge to the retreat. We gladly accept payments via cash or checks, which do not carry this fee. If you do not want to pay this charge, go back to the registration page and click “mail in registration”. Fill out the mail in registration form and mail a check to the address provided. Your comprehension and collaboration are sincerely valued, and we are dedicated to delivering the utmost quality service to you.

Stripe Credit Card