Contact Greenwood Villa - Bed & Breakfast Pinelands

Guest Registration

Please complete this form. All fields marked * are required.

First Name *

Surname *

Date of Birth *

ID / Passport *

Email *

WhatsApp / Contact Number *

Arrival Date *

Departure Date *

Room Name / Number *

Physical Address *

Emergency Contact Name *

Emergency Contact Number *

Reason for Travel *

Company Name

Dietary Requirements

Message *

Disclaimer and payment responsibility - READ CAREFULLY:

I/We hereby agree that the following are conditions of my/our occupation of Greenwood Villa:

The owners and staff shall not be held responsible for any injury sustained, or loss of, or damage to, my/our property, whether arising from fire, theft or from any other cause and by whomsoever caused, or arising from the negligence, gross or otherwise, or wrongful act of the owner/s or any other person in the employ of the owner.
I am responsible for payment in full for the accommodation and any additional costs incurred by me/us while I am/we are a guest/s at Greenwood Villa regardless of whether my company, agent or another person made the booking. Should another entity be responsible for payment I/we agree that I am/we are jointly and severally liable for the payment and that all payment is due and payable on or before departure.
I am aware there is an unprotected swimming pool on the premises and that I will ensure my own safety and that of my accompanying guests and children.
I am liable to pay on demand for any damage I may cause to the property including smoke residue, or any item/s belonging to Greenwood Villa and its owners.
SMOKING is not permitted in the building. There is an outside patio with an ashtray for smoking. Any guest smoking inside the building or in the room will be required to pay the full professional cleaning fee and the rate of a one night stay if the room cannot be used due to being cleaned.
I am aware that any extra person visiting me in my room at any time will be charged for at the normal daily rate unless permission has been granted by the owner or management and it has been agreed to waive this payment.
The person signing below does so on behalf of all the accompanying guests.

I/we have read and agree to contract with the owners on this basis.