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Summer 2020 Reservation Form Families Coping with a Child's Medically Complex Condition

Parents and Siblings (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 their children (immediate family only). PCA/Nurses are welcome during Medically Complex Programming.

  • Name
  • Birthday
  • Relationship
  • Name
  • Birthday
  • Relationship
  • Name
  • Birthday
  • Relationship
  • Name
  • Birthday
  • Relationship
  • Name
  • Birthday
  • Relationship
PCA or Nurse staying at Faith's Lodge (if any)
  • Name
  • Will they need their own room? (additional cost)
Emergency Contact
  • PLEASE CHECK THE BOX BELOW

    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).