Reservation Request Form
Please fill out this form to begin your reservation.
Email address *
Arrival & Departure
Expected Date of arrival: *
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Expected Time of arrival: *
Time
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Expected Date of departure: *
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Expected Time of departure: *
Time
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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? *
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 *
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.