Lets get some preliminary details! Give us some info about you, your group and some specifics of your stay with us. The more we know now, the better prepared we can be when you arrive!

Group Details

Fill out some basics, you name, group size etc. This will give us a good idea of who you are!

Retreat Info (Form A)

Group/Church Name *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Person(s) *

Who should we be in contact with for details?

Email *

Phone *

(###)

###

####

What type of group are you bringing? *

Let us know who you are so we can better serve you!

What dates are you coming? *

YYYY

What is your estimated Headcount? *

Give us an approximate!

ETA *

When are you planning on arriving?

Hour

Minute

Second

ETD *

*you may be asked to move your belongings out of the rooms earlier than your departure time*

Hour

Minute

Second

If able, please include any probable details regarding lodging, activities or meals that may help us prepare for your arrival. It is okay if these change!

Thank you! That’s the big part done, now on to some Liability and Insurance paperwork…

Liability

Lets fill out some liability information. This includes insurance and releases.

Liability Form

FIRST AND LAST NAME: *

Date: *

YYYY

By signing below, you agree that your group promises and warrants that it carries liability and medical payments insurance to cover the liability and medical payments exposures resulting from your group’s use of the Three Springs Ministries (“TSM”) facility. Your group will have TSM named as an Additional insured on your group’s policy and will provide a Certificate of Insurance to TSM showing TSM as an additional insured. Your group also agrees to hold harmless, indemnify and defend TSM from any and all liability which may result from any person using the facility’s buildings, its entrances and exits, and surrounding areas for your group’s purposes. *

Please type "I agree" below

I certify that all adult leaders and staff are in compliance with our state's certification and submission requirements in order to have contact with children. This pertains to PA laws Act 34 Criminal Record Check, Act 151 Child Abuse History Clearance, and Act 114 FBI Federal Criminal History Record. (Please refer to www. Keepkidssafe.PA.gov for detailed information to ensure compliance.) I further certify that there is nothing that would prohibit or disqualify all adult leaders and staff from our group from having contact with children. *

Please type "I Certify" below

Thank you for signing! We will be in touch if there are any further details regarding your legal responsibilities.

Now, on to the Insurance form…