Name *

First Name

Last Name

Phone

(###)

###

####

Which week are you interested in joining us? *

May 26th - June 1st

August 18th - 24th

November 3rd - 9th

Have you read our community living agreements, and do you agree to follow them while you are a guest in our home? *

To read, open this link - https://www.lostvalley.org/community-living-agreements

Yes

No

Do you consent to participating in our community dinner program during your stay? *

Participants are required to assist with one 2 hour cook shift, and one 2 hour clean shift for the week. Participants will also need to submit an Orgegon Food Handler's card prior to their arrival in order to work in our industrial kitchen.

Yes

No

Maybe