EmailMe Form - CBM Family Respite 2020

Name of person completing form *

First Last

CBM Area *

Dates and preferred lodging
First choice *

Dates and preferred lodging
Second choice *

Other:

Number of beds needed *

Adult 1 Name *

First Last

Gender

male

female

Email *

Meals Requested *

breakfasts

lunches

dinners

Dietary restrictions- allergies or sensitivities

Physical limitations
(for housing assignment purposes)

Please list up to 5 roommates (they must also request you)

Please note: single occupancy may not be available

Roommate 1

Roomate 2

Roommate 3

Roommate 4

Roommate 5

If single, are you willing to share a full/queen bed with someone of the same gender?

Please note: single occupancy may not be available *

yes

no

N/A

If single, are you willing to share with someone you don't know? *

yes

no

N/A

Are you willing to sleep in a top bunk? *

yes

no

Adult 2 Name

First Last

Gender

male

female

Email

Meals Requested

breakfasts

lunches

dinners

Dietary restrictions- allergies or sensitivities

Physical limitations
(for housing assignment purposes)

Please list up to 5 roommates (they must also request you)

Please note: single occupancy may not be available

Roommate 1

Roommate 2

Roommate 3

Roommate 4

Roommate 5

If single, are you willing to share a full/queen bed with someone of the same gender?

Please note: single occupancy may not be available

yes

no

N/A

If single, are you willing to share with someone you don't know?

yes

no

N/A

Are you willing to sleep in a top bunk?

yes

no

Adult 3

First Last

Email

Gender

male

female

Meals requested

breakfasts

lunches

dinners

Dietary restrictions
allergies or sensitivities

Physical limitations
(for housing assignment purposes)

Please list up to 5 roommates (they must also request you)

Please note: single occupancy may not be available

Roommate 1

Roommate 2

Roommate 3

Roommate 4

Roommate 5

If single, are you willing to share a full/queen bed with someone of the same gender?

Please note: single occupancy may not be available

yes

no

N/A

If single, are you willing to share a room with someone you don't know?

yes

no

N/A

Are you willing to sleep in a top bunk?

yes

no

Adult 4

First Last

Gender

male

female

Email

Meals requested

breakfasts

lunches

dinners

Dietary restrictions
allergies or sensitivities

Physical limitations
(for housing assignment purposes)

Please list up to 5 roommates (they must also request you)

Please note: single occupancy may not be available

Roommate 1

Roommate 2

Roommate 3

Roommate 4

Roommate 5

If single, are you willing to share a full/queen bed with someone of the same gender?

Please note: single occupancy may not be available

yes

no

N/A

If single, are you willing to share a room with someone you don't know?

yes

no

N/A

Are you willing to sleep in a top bunk?

yes

no

Child 1

First Last

Gender

male

female

Meals requested

breakfasts

lunches

dinners

Dietary restrictions
allergies or sensitivities

Physical limitations
(for housing assignment purposes)

Are you willing to sleep in a top bunk?

yes

no

Child 2

First Last

Gender

male

female

Meals requested

breakfasts

lunches

dinners

Dietary restrictions
allergies or sensitivities

Physical limitations
(for housing assignment purposes)

Are you willing to sleep in a top bunk?

yes

no

Child 3

First Last

Gender

male

female

Meals requested

breakfasts

lunches

dinners

Dietary restrictions
allergies or sensitivities

Physical limitations
(for housing assignment purposes)

Are you willing to sleep in a top bunk?

yes

no

Child 4

First Last

Gender

male

female

Meals requested

breakfasts

lunches

dinners

Dietary restrictions
allergies or sensitivities

Physical limitations
(for housing assignment purposes)

Are you willing to sleep in a top bunk?

yes

no

Child 5

First Last

Gender

male

female

Meals requested

breakfasts

lunches

dinners

Dietary restrictions
allergies or sensitivities

Physical limitations
(for housing assignment purposes)

Are you willing to sleep in a top bunk?

yes

no

Child 6

First Last

Gender

male

female

Meals requested

breakfasts

lunches

dinners

Dietary restrictions
allergies or sensitivities

Physical limitations
(for housing assignment purposes)

Are you willing to sleep in a top bunk?

yes

no

Child 7

First Last

Gender

male

female

Meals requested

breakfasts

lunches

dinners

Dietary restrictions
allergies or sensitivities

Physical limitations
(for housing assignment purposes)

Are you willing to sleep in a top bunk?

yes

no

Child 8

First Last

Gender

male

female

Meals requested

breakfasts

lunches

dinners

Dietary restrictions
allergies or sensitivities

Physical limitations
(for housing assignment purposes)

Are you willing to sleep in a top bunk?

yes

no