Genesis Spiritual Life and Conference Center, Inc.

GENESIS SABBATICAL GUEST APPLICATION

Choose "print" from your browser's menu to print this form. Once printed, please fill in all required information, and then FAX or MAIL the completed form to the address on the bottom of this page.

Your Name
Date

Address

Your Phone
Day: Evening:

Fax / E-Mail
Fax #: E-mail:

Member of
Religious Order Clergy Married Single

If member of religious order or clergy, please provide name of Order / Diocese and person to contact in case of emergency. If married or single, please give us the name of the person to contact in case of emergency:

Contact Name

Address

Contact Phone
Day: Evening:

How long do you wish to stay at Genesis?

Arrival Date:
Departure Date:

How did you hear about Genesis?

Please list some of your reasons for considering Genesis for your sabbatical:

Do you have any serious medical problems?   Yes____   No____     If yes, please indicate:

Do you have any difficulty walking?   Yes____    No____      If yes, please explain:

Please list any medications you are currently taking:

Please list any special dietary needs:

Please name someone we may call as a reference:

Reference Name

Address

Reference Phone
Day: Evening:

To whom should we send your monthly bill during your stay with us?

Billing Name

Address

What is your educational background? (Please check)
               High School_______        College_______       Masters / Doctoral Degree_______

Please describe your present ministry or occupation, as well as hobbies or special interests:

Please list your past ministries or occupations:

Will you have a car available for your use?       Yes____     No____

Are you interested in spiritual direction while at Genesis?      Yes____    No____

How would you describe your spirituality?

Please list your goals and priorities while on sabbatical:

ON A SEPARATE SHEET OF PAPER, PLEASE INCLUDE A BIOGRAPHICAL SKETCH.
If there is anything else you would like to share or that we should know in order to make your sabbatical time more comfortable or meaningful, please let us know on a separate sheet of paper. Send your form to:

Sr. Ann Horgan, SP
Sabbatical Coordinator
Genesis Spiritual Life Center
53 Mill Street - Westfield, MA 01085 USA
Fax: (413) 572-1060 / Email: genesis@genesiscenter.us
Acceptance will be confirmed upon receipt of application.

Back to Genesis' web site

Your Name					Date
Address
Your Phone	Day:			Evening:
Fax / E-Mail	Fax #:			E-mail:
Member of	Religious Order	Clergy		Married	Single
If member of religious order or clergy, please provide name of Order / Diocese and person to contact in case of emergency. If married or single, please give us the name of the person to contact in case of emergency:
Contact Name
Address
Contact Phone	Day:		Evening:
How long do you wish to stay at Genesis?
Arrival Date:			Departure Date:
How did you hear about Genesis?
Please list some of your reasons for considering Genesis for your sabbatical:
Do you have any serious medical problems? Yes____ No____ If yes, please indicate:
Do you have any difficulty walking? Yes____ No____ If yes, please explain:
Please list any medications you are currently taking:
Please list any special dietary needs:
*Please name someone we may call as a reference:*
Reference Name
Address
Reference Phone	Day:		Evening:
*To whom should we send your monthly bill during your stay with us?*
Billing Name
Address
What is your educational background? (Please check) High School_______ College_______ Masters / Doctoral Degree_______
Please describe your present ministry or occupation, as well as hobbies or special interests:
Please list your past ministries or occupations:
Will you have a car available for your use? Yes____ No____
Are you interested in spiritual direction while at Genesis? Yes____ No____
How would you describe your spirituality?
Please list your goals and priorities while on sabbatical: