HHR Form Long - Hayner Home

Hayner Hits the Road

Reservation Form

Long Trip

Each individual person registering for a Hayner Hits the Road trip should fill out this registration form and agree to our "Release of Liability" on the next page.

After you fill out this form, you will be directed to our "Release of Liability" form. Then you will be directed to our secure payment system. A deposit of $200 is required per person, per trip to complete your registration. Checks may be made payable to "Hayner Trips." However registration is not complete until a deposit is received. Your seat will be confirmed via email within three business days upon receipt of completed registration and deposit.

Checks are preferred. You may mail checks to:

Troy-Hayner Cultural Center Attn: Hayner Trips

301 W. Main St.; Troy, Ohio 45373

First we need to know a bit about you.

* indicates a required field

Your Name *

Email *

Phone Number *

Additional Phone Number *

Address *

Which trip are you registering for? *

How are you planning to make your payment? *

Online (You will be directed to our payment system when you hit the "submit" button at the bottom of the page.)

I will mail a check.

I will stop in the Hayner and make a payment.

How much will you be paying at this time? *

If you are paying by card, what is the name on the card? *

Do you prefer: *

One bed

Two beds

It does not matter to me at all

Now we need to know if you will have a roommate.

** Please note that your roommate will also need to complete a registration form and "Release of Liability" and pay a deposit.

Will you have a roommate? *

I will have a roommate.

I will not have a roommate.

If so, what is the name of your roommate.? *

Now we need for you to provide information about someone who is not traveling with you that can be your emergency contact.

* Indicates required field.

Name of your emergency contact *

Emergency contact's best phone number. *

Emergency contact's additional phone number.

When you hit the "SUBMIT" button you will be directed to our "Release of Liability and Waiver of Legal Rights" page. After that you will be directed to an online payment system if you wish to use a credit card for payment.