Reservation Request Form
Please fill out this form to begin your reservation.
* Required
Email address
*
Your email
Arrival & Departure
Expected Date of arrival:
*
MM
/
DD
/
YYYY
Expected Time of arrival:
*
Time
:
AM
PM
Expected Date of departure:
*
MM
/
DD
/
YYYY
Expected Time of departure:
*
Time
:
AM
PM
Occupant Info
Applicant Name
*
Include First and Last Name
Your answer
Group Member Names
*
Please include ages for kids 12 and younger.
Your answer
Room/Bed Selection
Enter number needed. Enter "0" if it does not apply.
Number of Single Beds Needed
*
5 Single Beds Total - Room 1 ($35 per-person per-night) = 1 Queen and 1 Single, Room 4 ($30 per-person per-night)= 2 Singles, Room 5 ($30 per-person per-night) = 1 Double and 1 Single
Your answer
Number of Double Beds Needed
*
2 Double Beds Total - Room 3 ($30 per-person per-night) = 1 Double, Room 5 ($30 per-person per-night) = 1 Double and 1 Single
Your answer
Queen Bed
1 Queen Bed Total - Room 1 ($35 per-person per-night) = 1 Queen and 1 Single
Your answer
Applicant Info
Applicant Current Address
*
Your answer
Applicant Email
*
Please re-enter email from above here.
Your answer
Applicant Home Phone
Your answer
Applicant Cell Phone
*
Your answer
Christian Church/Organization Info
Christian Church/Organization Name
*
Your answer
Contact Person's Name
*
Include First and Last Name
Your answer
Contact Email and/or Phone
*
Your answer
Church/Organization Website
Your answer
Emergency and Other Contacts
Emergency Contact Name
*
Include First and Last Name
Your answer
Emergency Contact Phone and/or Email
*
Your answer
Any Rockland Area Contact Name
*
Include First and Last Name
Your answer
Any Rockland Area Contact Phone and/or Email
*
Your answer
Additional Info
Would you like to receive periodic e-news about Crie Haven and regional events?
*
Yes
No
Not required but we would appreciate a short paragraph about you and/or your ministry:
Your answer
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 Director c/o 11 James St Rockland, ME 04841
*
Yes
Send me a copy of my responses.
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