APPLY TO USE FACILITY - Nehemiah Ministries

Name *

First

Last

Preferred title *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Daytime phone

Evening phone

Fax

Ministry/Organization

Position

Currently employed there?

Number of people joining you

I acknowledge that pets are not allowed on Nehemiah Ministries' property. *

I Understand

Desired services

Here are some of the resources and services that we provide to pastors, missionaries and other Christian leaders.
Please check those that you are interested in. While we cannot promise to provide everything you might request, we will do what we can.

Desired Services

Use of grounds and/or barn (attach explanation of your desired use)
Guest house for a personal or family retreat (on your own)
Guest house for a guided spiritual retreat with a trained staff member
I would like to volunteer time, talent or resources to assist your ministry in some way
Professional counseling by a licensed counselor (someone will contact you for details)
Nehemiah Rebuilder’s project – Eight day intensive (Limited availability. Call for schedule)

Grounds/Barn use explanation *

Dates of desired services:

(Check-in time is noon on the requested day and check-out time is 5 PM. If you need to make other arrangements please let us know and we will try to assist you.
(Guest house is typically not available for more than two weeks per visit)

Dates of desired check in: (First choice) *

Date of desired check out (First choice) *

Dates of desired check in: (Second choice) *

Date of desired check out (Second choice) *

Dates of desired check in: (Third choice) *

Date of desired check out (Third choice) *

Suggested $125 non-refundable application fee, plus a $25 daily use donation. *

Will pay via Paypal
Will mail you a check or money order separately
Contact me about other payment arrangements

Please acknowledge

Nehemiah Ministries is a 501c3 non-profit ministry in the State of Michigan. Donations are tax deductible.
Though we do not charge for our services, gifts and donations allow us to continue to make the ministry available to as many people as possible.

Acknowledgement *

I acknowledge

Please acknowledge

GENERAL TERMS OF USE:
First and foremost, Nehemiah Ministries and its facilities exists to bring honor and glory to God. As such, activities connected to the ministry that do NOT bring glory to God are prohibited.
Nehemiah Ministries reserves the right to determine unacceptable activities at the facilities. In the event that certain behavior or conduct is determined to be unacceptable, guest may be warned to refrain from it or asked to leave.
The following are some of the activities prohibited at Nehemiah Facilities: Smoking (except in designated areas), underage alcohol consumption, use of illegal (non-prescription) drugs, possession or use of firearms (without written permission from Nehemiah Ministries). Parking in undesignated areas, entering other residences, or disturbing other guests. Campfires or bonfires are not permitted except in designated areas. Guests are asked to be considerate of others who may be using the facilities at all times. Pick up any trash generated and dispose in provided container. Please be advised guests are expected to report any intentional or unintentional damage or abuse of the facilities. Nehemiah reserves the right to bill guests for damages.

Acknowledgement *

I understand the General Terms of Use above and accept responsibility for compliance for myself and for any who are a part of my group.

Please acknowledge

RELEASE OF LIABILITY:
I, and my heirs, in consideration of my participation in the use of Nehemiah Ministries Facilities on (dates), hereby release Nehemiah Ministries Inc, its officers, employees and agents, and any other people officially connected with this organization, from any and all liability for damage to or loss of personal property, sickness or injury from whatever source, legal entanglements, imprisonment, death, or loss of money, which might occur while participating in activities at Nehemiah Ministries.
I fully understand and agree that certain activities at this facility could be physically dangerous and that by participating in them risks of accidental or other physical injury exist. These risks may include, but are not limited to (1) travel to and from the Facility; (2) loss or damage to personal property; (3) injury or fatality due to (a) walking, running, jumping, swimming, blocking, tackling, kicking, colliding with others during play, and/or other physical activity, (b) head, neck and/or back injuries (c) inclement weather, and (d) exposure to outdoor terrain and conditions, which may cause slips, falls, falling objects, and/or heat exhaustion; (4) physical exertion; (5) emotional or psychological stress; and (6) suffering any type of injury or illness without immediate access to medical facilities, among others.

Agreement *

I understand that participation in these activities is strictly voluntary and I freely chose to participate. I understand that Nehemiah Ministries does not provide medical coverage for me in the event of injury. I verify that I will be responsible for any medical costs I incur as a result of my participation.

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USE OF FACILTY

Desired services

Dates of desired services:

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