Test Res Form – Fairhaven Ministries Canada

Individual, Couple or Immediate Family Reservation Request

Where the reservation includes individuals from multiple family units, select "Group Reservation Request"

Group Reservation Request

Name *

Last

Subsidy Confirmation *

The reservation request meets all 5 criteria and I am requesting the additional subsidy.

The reservation request does not meet the criteria and no further subsidy is requested.

Group or Event Name

First *

First

Spouse's name, as applicable?

Address *

Address

City

State/Province

Zip/Postal

Country

Ministry organization with which you are employed *

As vacancy permits, lay leaders may request retreat reservations upon the recommendation of their pastor.

Number of guests in reservation party *

Please be aware “immediate family” includes children 18 years of age and under, residing at home. Otherwise, additional charges apply.

Number of adults (over 18) *

Email *

Cell Phone *

Phone

Choose Check-in Date

Choose Check-out Date

Estimated Time of Arrival

Alternative Dates (if any)

Retreat Option

I would like to access counselling services while on site

Yes

No

To assist in determining your eligibility for a retreat subsidy, please check all of the following that apply: *

I am requesting a Self-Directed, Guided, or Co-Directed Retreat.

I am/my spouse is employed by a local church or para-church organization.

All members of our reservation party reside in the same residence.

The combined household income of the reservation party is less than $80,000.00/annum.

Costs associated with my/our retreat will not be reimbursed or covered by a third-party.

In the event all of the conditions are met, you may request a subsidy ($40.00/night) be applied to your retreat costs.

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