Cozy Home Stitches & Retreat Center
Registration Form
(To print this page click the right button on your mouse and select print from the menu)
To hold your spot return this form with a $25.00 deposit to:
Colleen Jacobson
105 S.Mantorville Ave
Kasson , MN 55944
The balance will be due upon arrival.
| Date Requested: | ________________________________________________ |
| Approximate arrival time: | ________________________________________________ |
| List any allergies or dietary needs | _____________________________________________________________________________________ |
| Name: | _____________________________________________________________ |
| Address: | _____________________________________________________________ |
| City: | _____________________________________________________________ |
| State/Zip code: | _____________________________________________________________ |
| Phone: | _____________________________________________________________ |
| E-mail: | _____________________________________________________________ |