Make a Reservation - Nonprofit, Free Pediatric Cancer Retreat for Kids

Apply here for a weekend at Chapel Hill House

Reservations can begin on Tuesday afternoon with checkout being on Thursday afternoon or Friday afternoon with checkout being Sunday afternoon.

Available

Booked

Pending

Partially booked

Parents/Guardians Names(required)*

Address*

City*

State*

Zip*

Phone*

Email*

Is your child currently being treated for cancer*

Child 1 Name*

Child 1 Age*

Is Child 1 a patient?*

Child 2 Name

Child 2 Age

Is Child 2 a patient?

Child 3 Name

Child 3 Age

Is Child 3 a patient?

Child 4 Name

Child 4 Age

Is Child 4 a patient?

Additional Guest Staying & Their Relationship

Does anyone have any physical restrictions or special needs?*

Physician Name*

Physician Address*

Physician Phone Number*

Address*