Reservation Request Form
Please fill out this form to begin your reservation.
Email address *
Arrival & Departure
Expected Date of arrival: *
MM
/
DD
/
YYYY
Expected Time of arrival: *
Time
:
Expected Date of departure: *
MM
/
DD
/
YYYY
Expected Time of departure: *
Time
:
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? *
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 *
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Crie Haven Ministries.