REGISTRATION FORM 
Please print in blue or black ink,  sign and Return one (1) copy of this registration sheet to:   Lakemont Retreat, 215 Liberty Street, Santa Cruz, CA 95060-6514 or FAX to 1-831-420-1782

Date In    ___________ (Check In after 3pm)                              Pets    yes or no

Date Out ___________ (Check out before 11 am)                     Total # of nights        ________

Legally Responsible Party Over 21 ________________________________________________

Permanent Address ____________________________________________________________

City_______________________ State _____________________ Zip ____________________

Home Telephone (_____) __________________ Cell Phone (______) ___________________

Passport #______________________________  Country  _____________________________

Drivers License: _________________________   State  _______________________________

Email address ________________________________________________________________

Guest # 2 ___________________________   Guest # 5 _______________________________

Guest # 3 ___________________________   Guest # 6 _______________________________

Guest # 4 ___________________________   Guest # 7 _______________________________

Unit B Guest # 8 _____________________

Automobiles of ALL guests:
License ________________ State_________________ Make __________________
License ________________ State_________________ Make __________________

** I have reviewed and agree to follow all the policies of Lakemont Retreat **

Signed:_________________________________________________________________________
Print Name:  _____________________________________ Date __________________________