Reservation Form for Bereaved Grandparents

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. A $50 non-refundable fee must accompany your guest reservation. 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

Reservation fee: $50 (one-time fee per family, per stay)
First-time guests: $99/per night/per room
Returning guests: $249/per night/per room

Requested Dates of Stay

Please share the name of your grandchild who has died*

Date of Birth*
Cause of Death*
Age at Time of Death*
Date of Death*

Parents of child

Parent 1 First Name*
Parent 1 Last Name*
Parent 2 First Name
Parent 2 Last Name

Grandparents staying at Faith's Lodge

Grandparent 1 First Name*
Grandparent 1 Last Name*
Grandparent 2 First Name
Grandparent 2 Last Name
Home Address*
City*
State*
Zip*
Home Phone*
Cell Phone (Grandparent 1)*
Cell Phone (Grandparent 2)
Work Phone (Grandparent 1)
Work Phone (Grandparent 2)
Email Address*

Emergency Contact

Name*
Address*
Home Phone*
Cell Phone*

Hospital Source

Hospital or Organization Grandchild Treated At*
City*
State*
Attending physician

Person completing this application*

How did you hear about Faith's Lodge

How did you hear about Faith's Lodge*

Gift Certificate Code
Please enter the code from the lower left corner of your gift certificate

I am a past guest and have stayed at Faith's Lodge before. I understand I will be charged the return guest rate.

I need a room with a handicapped shower.

Faith’s Lodge Photo & Video Release Consent (optional): I/We hereby give to Faith’s Lodge, its successors or assigns, the unconditional right to use and reproduce in any of its printed and online publications (including but not limited to newsletters, annual reports, websites, social media posts and blog posts) all pictures, videos and duplicates thereof, that it have obtained of myself.

I/we understand and recognize staying at Faith’s Lodge is contingent on approval of this application as well as compliance with all conditions, qualifications and restrictions designated by Faith’s Lodge.

Payment Options (please check one)*

Reservation fee only: $50Reservation Fee Only (non-refundable)
Reservation fee only: $50

Three night stay and reservation fee: $297First Time Guest Pay in Full (non-refundable)
Pay for your stay in advance and waive the $50 reservation fee
Three night stay total: $297

Three night stay and reservation fee: $747Return Guest Pay in Full (non-refundable)
Pay for your stay in advance and waive the $50 reservation fee
Three night stay total: $747

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. Registration fees are non-refundable if a guest cancels.