Reservation Request Form

Please fill out this form to begin your reservation.

Email address *

Arrival & Departure

Expected Date of arrival: *

YYYY

Expected Time of arrival: *

Time

Expected Date of departure: *

YYYY

Expected Time of departure: *

Time

Occupant Info

Applicant Name *

Include First and Last Name

Group Member Names *

Please include ages for kids 12 and younger.

Room/Bed Selection

Enter number needed. Enter "0" if it does not apply.

Number of Single Beds Needed *

5 Single Beds Total - Room 1 ($40 per-person per-night) = 1 Queen and 1 Single, Room 4 ($35 per-person per-night)= 2 Singles, Room 5 ($35 per-person per-night) = 1 Double and 1 Single

Number of Double Beds Needed *

2 Double Beds Total - Room 3 ($35 per-person per-night) = 1 Double, Room 5 ($35 per-person per-night) = 1 Double and 1 Single

Queen Bed

1 Queen Bed Total - Room 1 ($40 per-person per-night) = 1 Queen and 1 Single

Applicant Info

Applicant Current Address *

Applicant Email *

Please re-enter email from above here.

Applicant Home Phone

Applicant Cell Phone *

Church or Organization Info

Christian Church/Organization Name *

Contact Person's Name *

Include First and Last Name

Contact Email and/or Phone *

Church/Organization Website

Emergency and Other Contacts

Emergency Contact Name *

Include First and Last Name

Emergency Contact Phone and/or Email *

Any Rockland Area Contact Name *

Include First and Last Name

Any Rockland Area Contact Phone and/or Email *

Additional Info

Would you like to receive periodic e-news about Crie Haven and regional events? *

Yes

Not required but we would appreciate a short paragraph about you and/or your ministry:

Yes, I understand that once I have been notified by email about my accommodation availability, a deposit of 50% will confirm my reservation. Checks should be mailed to Crie Haven Director c/o 161 Yamacraw Place, Lexington, KY 40511 *

Yes

Thank You!

This application information will be forwarded to a Crie Haven Director at info@criehavenministries.org.

A copy of your responses will be emailed to the address you provided.

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This form was created inside of Crie Haven Ministries.