Application

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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.

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

Fill out the ONLINE APPLICATION below and submit it. (recommended)
Download the Guest Application PDF and mail it to the address provided.
Contact Us with the information we’re requesting below.

Before you fill out the form below, please check the retreat schedule for availability.

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

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.

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

Add All Family Members that will be Attending.
NAMES WILL BE PRINTED ON CAMP ROSTER AS LISTED

Name	Gender	Date Of Birth	Disability If Any
Husband/Father		MM-DD-YYYY
Wife/Mother		MM-DD-YYYY
Child 1:		MM-DD-YYYY
Child 2:		MM-DD-YYYY
Child 3:		MM-DD-YYYY
Child 4:		MM-DD-YYYY
Child 5:		MM-DD-YYYY

Step 3 of 5 Referral Information

How did you learn about Barren Heights?

Describe any prior camp experiences?

Describe your most recent vacation experiences?

Have you attended a Barren Heights Retreat previously? If so, when? Our policy is to welcome previous visitors only when there are last minute cancellations or a cabin is vacant 15 days prior to a scheduled retreat.

Step 4 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)

How does your child's (children's) disability impact your family on a day-to-day basis? *

Step 5 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 #

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

All application information is kept confidential. Application information may be shared with retreat volunteers so they are better equipped to serve your family. This information will not be distributed or used for marketing purposes.

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