Name:

Address:

Address(Cont.):

City:

State:

Zip:

Phone:

Email:

Dates Requested:

Referred By:

Church Name & Tax ID Number

Number of Guests:

Ages of Children:

Arrival Time (After 12:00 PM):

What are the spiritual expectations of your visit?

Food Service:

Breakfast

Continental: $3/person, $1 for children 4-6 years, 3 and under is free:

Cold: $4/person, $2 for children 4-6 years, 3 and under is free

Hot: $6/person, $3 for children 4-6 years, 3 and under is free

Indicate Days and Type

 Yes No

Brunch ($6.00 / $3.00 for children 4yrs. - 6yrs.):
Indicate Days

 Yes No

Lunch ($7.50 / $5.00 for children 4yrs. - 6yrs.):
Indicate Days

 Yes No

Supper ($9.50 / $6.00 for children 4yrs. - 6yrs.):
Indicate Days

 Yes No

PLEASE NOTE ANY SPECIAL DIETARY NEEDS

Remarks and Special Requests: