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Reservation Form for Bereaved Families of Medically Complex Child 2020

Parents and Surviving Children (Immediate Family only)

To provide you with the best possible experience at Faith’s Lodge, your reservation form must be filled out completely. Please be assured that all information will remain confidential. We regret that we will be unable to review and process incomplete forms. Every effort will be made to honor your requested date of stay; however, space is limited. Reservations are processed in the order received and all information is confidential.

 

 

Rates 

The costs associated with this weekend (including your nightly rate and reservation fee) are fully covered thanks to The Richard Schulze Family Foundation, Pediatric Home Service and “Have a Heart” Campaign donors!

    Parents staying at Faith's Lodge
    Children staying at Faith's Lodge

    Family weekends at Faith's Lodge are for parents and surviving siblings (immediate family) only.

    • Name
    • Birthday
    • Relationship
    • Name
    • Birthday
    • Relationship
    • Name
    • Birthday
    • Relationship
    • Name
    • Birthday
    • Relationship
    • Name
    • Birthday
    • Relationship
    Emergency Contact
    • Please check this box

      Please check this box to avail of the sponsored weekend (free of charge)
    • Referrer Details


      Referrer Details




    Hospital Source
    • Please enter the code from the lower left corner of your gift certificate
    Payment Options (please check one)*

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    Cancellation Policy

    Faith’s Lodge reserves the right to make schedule modifications as needed based on demand, conditions and other unforeseen circumstances.  Should your program date be changed or cancelled by Faith’s Lodge, such changes will be communicated at the earliest possible date.  Faith’s Lodge will attempt to reschedule the stay, but if rescheduling is not an option for the guest, then Faith’s Lodge will refund the registration fee.  Should the guest need to reschedule their reserved stay for any reason, registration fees can be applied to a future program of the guest’s choice.  Registration fees are non-refundable if a guest cancels (and chooses not to reschedule).