2024 Bernard Creeger House Application
One application for each guest over the age of 5 years old. 

Email *
In order to stay in the BC House, you must agree to the guest guidelines which can be found  HERE and on the Bikur Cholim of Greater Washington website. Please read and then click below:  *
Required
 First and Last Name *
Email Address
Street Address *
City *
State
Country *
Cell phone number ( whatsapp or local number) *
Will you be bringing any children five and under? ( for children over five you will need to fill out a separate guest application). Please list the names and ages. *
Rabbi name and contact information for reference *
Second reference ( not a family member) name and contact information *
How did you hear about Bikur Cholim of Greater Washington and the Bernard Creeger Bikur Cholim House? *
Please explain the purpose of your visit. *
Which hospital will you be visiting or a patient at. *
What is the name of the doctor who is directing your care of the care of your loved one? *
We will need a valid ID to be scanned and sent to our office. Please scan and send to info@bikurcholimgw.org and write ID in the subject line.  *
We require a valid credit card on file to be charged in the event of any damage that you are liable for over $100. Please enter the card number and expiration date. We will call you to verify the number and may ask you if we can charge $5.00 to test that the card is working *
Please list the Date that you anticipate arriving.
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Please list the date that you anticipate checking out.
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Please check your arrival time. Guests can only check in after 9:00 am and before 8:00 pm  *
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