Name:______________________________________________

Phone:______________________________________________

Home or Permanent Address

_____________________________________

______________________________________

Person To Call In Case of Emergency

______________________________________

Phone_________________________

Relation of person to be called______________________

Number of people who will be living in your RV______________________________

Name(s) & relation of other people living with you on the Campground.  Unmarried live-ins will not be permitted since this is a church campground. 

_________________________________________

_________________________________________

_________________________________________

Place of Employment____________________________________

Phone # at Place of Employment__________________________

Date Moved In_________________________

Rent is due on the first of the month. Rent will be prorated by the day from today till the first of the month.  

I have received a copy of the regulations and hereby agree to abide thereby.

Signature__________________________________

Date___________________

We will need copy of your Drivers License.