Printable Request Form

Please print and mail your completed form to the following address:

Genesee Home
7202 Genesee Road
Taylorsville, CA
95983

Please tell us how you heard about Genesee Home. We want to be good stewards of Genesee Home's funds and value your answer to this question so we can best direct our marketing efforts. Please check all that apply:

* indicates a required field

* Your Full Name:

* Spouse's Full Name:

* Anniversary Date:

(mm/dd/yyyy)

* Husband's Birthdate:

(mm/dd/yyyy)

* Wife's Birthdate:

(mm/dd/yyyy)

* Size of Family:

* Street Address:

* City:

* State:

* Zip Code:

please enter 10-digit phone numbers without spaces or dashes, e.g 5302841082

* Home Phone:

* Work Phone:

* Email:

* Church/Ministry Name:

* Average Attendance:

* Denomination:

* Year of Ordination:

* Your Position:

* Descrition of your Ministry:

* Special Needs:
Food allergies, diabetic, vegetarian, etc, please explain fully.

* Other Special Needs:
Please explain anything that may help us accomodate any special needs.

* Emergency Contact Name:

* Contact's Phone Number:

PLEASE CHECK OUR WEBSITE FOR AVAILABLE ROOMS/DATES IN ORDER TO COMPLETE THIS NEXT SECTION
You may also call us at (866) 715-REST or (530).284.1082 for room inquiries.

PREFERRED DATES: Please choose 3 dates in order of preference and we'll make every effort to accomodate your first choice, but would like to respond with others if it is unavailable. All dates are Sunday - Friday.

Please note: You should plan to arrive after 3:00 PM on Sunday afternoon and before 6:00- PM and depart after 11:00 AM on the following Friday.

A determination email will be sent within 48 hours of our receipt of your request to the email address provided.

* 1st Choice:

(mm/dd/yyyy)

* 2nd Choice:

(mm/dd/yyyy)

* 3rd Choice:

(mm/dd/yyyy)

Indicate in the comment box below if your selected dates are of particular importance.



Garden Room 258 ft²	Genesee Room 365 ft²	Hosselkus Room 321 ft²	Meadow Room 426 ft²	Parlor Room 417 ft²

Please list your 1st, 2nd, and 3rd choice of accommodations.
We will do our best to honor your choice of room; however, rooms are assigned on a "first come-first serve" basis.

* 1st Room Choice:

* 2nd Room Choice:

* 3rd Room Choice:

Indicate in the comment box below if your selected rooms are of particular importance.

Do you intend to coordinate your visit with any other individuals? Yes No

* If Yes, Provide Name:

How will you be traveling to Genesee Home? By Car By Plane

SCHOLARSHIP OPPORTUNITIES: Genesee Home has a limited number of scholarships available to assist Pastors who are unable to afford the cost of a visit. Please describe the reasons you desire assistance and the amount of assistance you are requesting.

* Please briefly describe your Sabbath week desires at Genesee Home:

Comments:

We are unable to accommodate children or pets. A visit to Genesee Home is not intended to be a vacation; it is a restful setting where you and your spouse can be refreshed, restored and renewed through time alone, time with God and interaction with each other.

Before you submit your request, please read and acknowledge your agreement with our Statement of Faith.

By signing below, you show that you have read and agree with Genesee Home's Statement of Faith.

* Signature:

* Printed Name:

* Date:

Deposits:

1. Within two weeks of receiving confirmation of their reservations, guests will be required to pay a $100 deposit. The remaining balance of the guest's portion of the weekly expense must be received 60 days prior to arrival. 2. Guests booking a reservation less than 90 days in advance of their arrival will be required to pay infull within 2 weeks of confirmation of reservation.

Cancellation Policy:

1. Cancellations received 60 days prior to arrival date will receive a full refund of all monies on deposit. 2. Cancellations received 30 to 59 days prior to arrival will receive a 50% refund of all monies on deposit. 3. Cancellations received less than 30 days prior to arrival will forfeit all monies on deposit. 4. However, if the cancelled room is rebooked at any time prior to their scheduled arrival date, 100% refund will be provided.