Application

Application Please Read

Please Read

Barren Heights provides FREE Family Enrichment Weekends to qualifying families. In order to hold your spot at the retreat, we require a $50 deposit (Either by mailing $50 check or online via Paypal) This reservation fee is due within 10 days of your application approval. The reservation fee is fully refunded after your stay or upon canceling 30 days in advance of your scheduled visit.

Financial assistance can be provided. Call (502) 327-9495 for details.

Please contact us if you have interest in volunteering at Barren Heights.

There are several ways to apply for a Family Enrichment Retreat:

Fill out the ONLINE APPLICATION below and submit it.
Download the Guest Application PDF and mail it to theess included.
Contact Us with the information we’re requesting below.

Before you fill out the form below, please check the retreat schedule. Reservations are accepted on a first come first served basis.

In an effort to serve as many families as possible, prior visitors are welcome to apply when there are last minute cancellations or when a cabin remains available 15 days prior to the scheduled retreat.

Application

Step 1 of 5 Retreat Dates

Choose your Desired Weekend Choose a Alternative Weekend

Primary Contact Information:

First Name * Last Name *
Primary Phone * Cell Phone
Street Address * Address Line 2

City * State / Province / Region *

Postal / Zip Code * Country
Primary Contact Email *

Emergency Contact:

First Name * Last Name *
Emergency Phone * Emergency Cell Phone

Step 2 of 5 Family Members Attending

It is our policy not to accept applications for single-cabin accommodations for unmarried couples. Please Contact Us if you have any questions about this policy. It is our desire to rejuvenate and strengthen families. Therefore, we encourage husbands and wives to attend together.

Add All Family Members that will be Attending.

Husband or Father:	MM-DD-YYYY	Disability if Any
Wife or Mother:	MM-DD-YYYY	Disability if Any
Child 1:	MM-DD-YYYY	Disability if Any
Click to Add Another Child

Step 3 of 5 Family Medical Information

(please provide details for each family member)

Drug Allergies: * (reactions / complications)

Medications: * (include dosage if known)

Food Restrictions: * (allergies or special requirements)

Medical Conditions: * (considerations and/or limitations)

Step 4 of 5 Insurance Information

Information will be used for emergency X-rays or other medical consultations.

Person who insures camper * Company name if group insurance
Name of insurance Co * Insurance Phone
Street Address * Address Line 2

City * State / Province / Region *

Postal / Zip Code * Country
Policy # Medicaid #

Step 5 of 5 Additional Information

How did you hear about Barren Heights?

Do you have any comments or questions?

Barren Heights accepts new reservations on a first come, first served basis.

Please allow 1-2 weeks for application to be processed. To check on status of application, please contact us by e-mail or phone at (502) 327-9495.

All application information is kept confidential.

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