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Discover Dates
Date of Weekend:
Personal Data
First Name:
Last Name:
Sex:
Primary Address:
Secondary Address:
City:
State:
Postal Code:
Phone Number:
E-mail:
Expected H.S. Grad Year:
High School:
Church:
Expected Arrival Time:
Expected Departure Time:
Medical Liability Waiver

Please have your parents complete and sign the Medical Liability Waiver. We ask all Discover Rosedale participants to bring a signed waiver along with them.

Group Data

If you are coming with an organized group, and know any of the following information, please complete this section. If you are making independent arrangments, this section does not apply.

Sponsor Name:
Sponsor Address:
Sponsor City, State, Zip:
Sponsor Phone Number:
Sponsor E-mail:

Names (if known) of others in your group: