Accommodation Request

Arrival Date*
MM slash DD slash YYYY
Departure Date*
MM slash DD slash YYYY
Have you stayed at Siloam Missionary Homes before?*
- Yes
- No
If no, how did you hear about Siloam Missionary Homes?
Number of Applicants*
Please enter a number from 1 to 12.
Primary Applicant
Name (First & Last)*
Birthdate*
MM slash DD slash YYYY
Gender*
- Male
- Female
Additional Applicants
Name (First & Last)
Birthdate
MM slash DD slash YYYY
Gender
- Male
- Female
Relationship to Primary Applicant
Name (First & Last)
Birthdate
MM slash DD slash YYYY
Gender
- Male
- Female
Relationship to Primary Applicant
Name (First & Last)
Birthdate
MM slash DD slash YYYY
Gender
- Male
- Female
Relationship to Primary Applicant
Name (First & Last)
Birthdate
MM slash DD slash YYYY
Gender
- Male
- Female
Relationship to Primary Applicant
Name (First & Last)
Birthdate
MM slash DD slash YYYY
Gender
- Male
- Female
Relationship to Primary Applicant
Name (First & Last)
Birthdate
MM slash DD slash YYYY
Gender
- Male
- Female
Relationship to Primary Applicant
Name (First & Last)
Birthdate
MM slash DD slash YYYY
Gender
- Male
- Female
Relationship to Primary Applicant
Name (First & Last)
Birthdate
MM slash DD slash YYYY
Gender
- Male
- Female
Relationship to Primary Applicant
Name (First & Last)
Birthdate
MM slash DD slash YYYY
Gender
- Male
- Female
Relationship to Primary Applicant
Name (First & Last)
Birthdate
MM slash DD slash YYYY
Gender
- Male
- Female
Relationship to Primary Applicant
Name (First & Last)
Birthdate
MM slash DD slash YYYY
Gender
- Male
- Female
Relationship to Primary Applicant
Contact Information
Correspondence Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone (Primary)*
Email (Primary)*
Phone (Secondary)
Email (Secondary)
Ministry Information
Field of Service*
Present Ministry Status*
- Regular missionaries on regular or medical furlough
- Retiring foreign missionaries who have just completed life-time service
- Home missionaries on regular or medical furlough
- Approved missionary appointees on deputation work
- Other Christian workers with fundamental, established Christian organizations
- Retired missionaries or retired Christian workers
Years of Service*
Date you arrived from the field?*
MM slash DD slash YYYY
Date you plan to go/return?*
MM slash DD slash YYYY
Give a brief account of your conversion (and your spouse's, if applicable)*
Give a brief resume of your ministry experience*
Name of Home or Sending Church*
Home or Sending Church Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mission Board Information
Mission Board*
Name of Person You Are Accountable to:*
Mission Board Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mission Board Phone Number*
Website
Educational Background
Please fill out all that apply.
Bible School*
College
Seminary
Do you have any emergency or medical training? If so, please explain or list your training/experience.*
Emergency Contact
Name*
Relationship*
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Additional Information and Acknowledgements
Have you or anyone living in your household who will be staying at Siloam Missionary Homes, or who will be visiting with you at Siloam, been accused of, involved in, or convicted of a sexual crime?*
- Yes
- No
If yes, please explain:
Background Check Approval*
- I understand that after I submit this application, I will be given the opportunity to submit the Background Authorization Form on the next page, which is required to complete the accommodation application.
We have carefully read the Policies & Procedures and Doctrinal Statement of Siloam Missionary Homes, and we agree to willingly and conscientiously accept them and will abide by them.
Policy Agreement*
- Yes
- No
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Name
This field is for validation purposes and should be left unchanged.

Your reservation deposit of $225 incorporates a $25 administrative fee that includes up to two adult background checks. If you have additional applicants 18 or older the additional background check fees will be added to your first invoice.

THIS APPLICATION WILL NOT RESULT IN A CONFIRMED RESERVATION UNTIL A NON-REFUNDABLE RESERVATION DEPOSIT OF U.S. $225 AND THE BACKGROUND CHECK AUTHORIZATION FORM HAS BEEN RECEIVED BY SILOAM MISSIONARY HOMES. PLEASE NOTE: THE RESERVATION DEPOSIT IS NOT REFUNDABLE IF THE RESERVATION IS CANCELLED.

Note regarding deposit: This deposit will be refunded 60 days from departure date, less any outstanding telephone and electric charges, damage to the duplex (other than normal wear & tear), cleaning or rubbish removal.

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1053 Quakenbush Rd

Snow Camp, NC 27349

336.376.8200

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Primary Applicant

Additional Applicants

Contact Information

Ministry Information

Mission Board Information

Educational Background

Emergency Contact

Additional Information and Acknowledgements

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