Section 1

First Name*

Last Name*

Address*

Phone Numbers

Cell

Home

Email address*

Reason For Visit*

Section 2

Are you a member of The Mother Church?*
YesNo

Are you a member of a branch church?*
YesNo

Section 3

Name of Journal-listed CS practitioner*

Phone #*

Email address

Section 4

Name of Emergency Contact*

Relation*
FatherMotherSonDaughterBrotherSisterHusbandWifeGrandfatherGrandmotherCousinUncleAuntNephewNiece

Contact's Phone Numbers

Cell

Home

Contact's Email address

Section 5

Morning Light Foundation's standards and mission are in accord with the teaching, study, and practice of Christian Science, which includes radical reliance on Christian Science for healing and freedom from medication.

Individuals who stay at Morning Light Lodge must be supportive of our mission and healing atmosphere and live in accord with the standards of Christian Science during their stay.

Rest and Study accommodations are for Guests who are independent and do not require Christian Science Nursing Care or personal assistance.

Your submission of this form indicates your understanding of these statements, and you affirm to abide by these standards during your stay at Morning Light Lodge:

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