This form must be completed and submitted along with your security deposit and insurance policy prior to receiving confirmation of your stay. Ministry or Group Name Group Type Phone Number Street Address City State ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Name of Group Leader(s) Phone Number Cell Phone Number Email Address Desired Day & Time of Arrival Expected Day & Time of Departure Total Number In Your Group (Estimate if unsure) Insurance Policy How did you hear about Mountain Fellowship Camp? As the group leader, I have read the “Conditions of Use” and our group agrees to abide by those conditions during our stay at Mountain Fellowship Camp. Furthermore, we hereby release and discharge Mountain Fellowship Camp, its officers, directors, employees, agents, and/or volunteers from any claims of action, costs, obligation, or financial responsibility resulting from or arising out of any incident, injury, or accident occurring while our group is attending Mountain Fellowship Camp. I further understand that photographs of our group enjoying the camp may be taken by or shared with the Mountain Fellowship Camp staff and may be used by Mountain Fellowship Camp for promotions, brochures, web design, Facebook and/or any other form of promotion or advertisements. Any photographs taken by or shared with the Mountain Fellowship Staff become the property of Mountain Fellowship Camp. By clicking send you are agreeing to the conditions of use.