Stay With Us!

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.

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Parents/Guardians Names(required)*:

Address*:

City*:

State*:

Zip*:

Phone*:

Email*:

Has your child gone through any sort of oncology treatment in the past year? Our criteria to stay is that the patient child is or has been in treatment within the past 2 years.*:

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*: