Quinipet Pastor Retreat Registration

Welcome! We look forward to hosting you for a relaxing stay at our beautiful camp.

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* 1. How many are in your group?

	Adults	Children
Pastor and family	Pastor and family Adults menu	Pastor and family Children menu

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* 2. Primary Guest Information (Your information)

Name (First & Last)

Email Address

Phone Number

Mailing Address (Street, City, State)

NYAC Church affiliation

Dietary restrictions (if food service is being provided)

Allergies

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* 3. Additional Guest Information

Guest 2

Youth or adult

Dietary restrictions (if food service is being provided)

Allgergies

Guest 3

Youth or adult

Dietary restrictions (if food service is being provided)

Allergies

Guest 4

Youth or adult

Dietary restrictions (if food service is being provided)

Allergies

Guest 5

Youth or adult

Dietary restrictions (if food service is being provided)

Allergies

Guest 6

Youth or adult

Dietary restrictions (if food service is being provided)

Allergies

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* 4. Emergency Contact Information
Please inform this person of their responsibilities as Emergency Contact.

Name

Phone Number

Email

Relationship to Primary Guest

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* 5. Check in is from 2 pm onward on the day of your arrival. Check out is by 11 am. Housing is generally provided in the nurse's apartment but may be in a different building depending on availability. Please list your desired dates below.

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* 6. Please indicate below:

I am requesting linens. (single bed sheets, blanket, pillow, towel, washcloth)

I am bringing my own linens.

TERMS & CONDITIONS
I agree to the following terms and conditions:

I understand that pets are not permitted and that Quinipet is a smoke free facility.
I understand and agree to the bed space limitations of the building where I am housed.
I agree to follow the established clean up and check out procedures, which are outlined in the attached Retreat Group Responsibilities.
I recognize the risks associated with staying at Quinipet, and do not hold the New York Conference of The United Methodist Church responsible or legally liable unless losses and/or injury results directly from the negligent or willful act of staff acting within the scope of their responsibilities.
I understand that if I become incapacitated and emergency care is needed, the camp will contact the local EMS for care.
I understand that I am financially responsible for any and all medical expenses, including prescriptions, incurred on behalf of myself and my guests.
I agree to abide by all established COVID-19 protocols in place at the time of my visit.

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* 7. Please indicate below:

I have read and accept the Terms and Conditions outlined above and the attached Retreat Group Responsibilities.

You will receive a confirmation of your reservation via email. See you at camp!