Tell me about yourself and roommate(s) List any special needs.

• Name
• Address
• Phone
• E-mail
• Congregation
• Emergency contact number
• Passport #

• Name
• Address
• Phone
• E-mail
• Congregation
• Emergency contact number
• Passport #

• Name
• Address
• Phone
• E-mail
• Congregation
• Emergency contact number
• Passport #

• Name
• Address
• Phone
• E-mail
• Congregation
• Emergency contact number
• Passport #

List the age of each child.

Please send your information by email:

(you can copy and paste this form) to:

[email protected] or mail to address below.

Submit this reservation form with your deposits.

To submit payment by paypal send to [email protected]

or 

Mail check or money order to: 

Christann Baxter

PO Box 232

Newton, Al 36352