Name *

First Name

Last Name

Date of Arrival *

MM

DD

YYYY

Please read and check appropriate box. *

I am aware of the highly contagious nature of COVID-19. I acknowledge that I am engaging the services of The Upper Room Ministries, Inc with knowledge of the danger involved. I further acknowledge that The Upper Room Ministries, Inc cannot guarantee that I will not become infected with COVID-19. I hereby agree to accept and assume all risks of personal injury, illness, disability, or death related to COVID-19 arising from being on the premises.

Yes

No

Please read and check appropriate box. *

I agree to conduct myself in appropriate behavior and that I may lose the privilege of using the space if my actions are inappropriate in person or online and will not receive a refund.

Yes

No