Molly's House Inquiry Form

Group Leader Name*

Group/Organization Name*

Email*

Phone*( ) -

Alternate Phone( ) -

Preferred Method of Communication*

Phone

Text

Check all that apply.

How did you hear about us?*

Preferred Arrival Date

Check-in time is no earlier than 4:00pm.

Preferred Departure Date

Check-out time is no later than 9:00am.

Proposed Number of Participants

Age Range of Participants

Names and Ages of Chaperones

Chaperones over age 25 are required for groups with participants age 21 and under.

Additional Information / Questions

Please leave this field blank.