(All participants must be at least 21 years old.)
226 Camp Rockfish Rd., Parkton, NC 28371
Phone: 910-425-3529 or 1-866-762-3474, Fax: 910-875-6177
All blanks need to be completed with requested information.
Date of Reservation Form:____/___/____ Group Name: __________________________________________________
Person Submitting Form:_________________________ Contact Person:______________________________
Contact Person's Address:_____________________ City/State:_____________________ Zip:_____________
Home Phone: ( )____________________ Work Phone: ( )_____________________
Email Address:_________________________________________________________
Dates Requested: From:_________________________To____________________________
Date Arrival Time Date Departure Time
Room rates are a flat rate based on the number of nights staying, not the number of persons in a room. (Maximum number of persons in a room is three (3) with 72 being the maximum number we can accommodate.)
In order to be guaranteed use of the Bergland Conference Room you must book (and be willing to pay for) a minimum of fourteen (14) rooms for two (2) or more nights with a minimum of 36 people eating no less than four (4) meals. Additional meeting spaces, if available, will cost $100.00 per space per day.
One (1) meeting space in the Dining Hall will be provided for groups not meeting the minimum requirements. Additional meeting spaces (if available) may be provided at $100/per space per day. Rockfish reserves the right to assign meeting spaces according to group size, needs and space availability.
Room Rates:
$95.00 per room per night if staying two (2) or more nights ($190. per room for a two-night stay)
$110.00 per room if staying only one (1) night
A 25% deposit is due upon return of this signed, completed form.
Final payment is requested the week prior to, or at the time of, the event.
(Please initial here that this statement has been read and understood): _________
Please note: Food is NOT allowed in the Bergland rooms . There will be additional charges of $25.00 per room for any cleaning associated with food being eaten in the rooms. Also note: There will be a $25.00 charge (plus shipping costs) for returning any items left by group participants.
The following portion of this Agreement/Reservation Form must be completed thoroughly.
Number of Nights your group will be staying:______ Total number of persons : _______
Number of Rooms needed _____ and the breakdown: # of Singles:____ #of Doubles:____
#of Triples:____. Total number of rooms wanting "Maid Service":_______
Maid Service: If you would like a staff person to change linens, towels and tidy up rooms during your stay, there is an additional charge of $10.00 per room per day. The request for this service has to be noted above.
Meals: Purchasing all meals and snacks through our Dining Hall is a requirement while staying at Rockfish. Meals are served buffet style in the Dining Hall (8:00 am Breakfast; 12:00 Noon Lunch; and 6:00 pm Dinner.)
Cost is $24.00/person/day for 3 meals; $16.00/person/day for 2 meals; $9.00/person/day
for one meal. We also have a “plate-served” $25.00/person prime rib meal (with an option of turkey, ham or chicken breast for people not wanting the prime rib) served with vegetables, tossed salad, rolls, dessert, and beverages. Rockfish does not provide menus
Please indicate the meals your group will want (and, if/when you want the $25.00 meal):
Friday: _______________________________________; Saturday: _______________________________; Sunday: ____________________________.
Please indicate the number of vegetarians in your group ______?
Snacks: $2.00 or $4.00/person/snack. $2.00 snack includes beverage, pretzels & cookies; $4.00 snack includes beverage, grapes, pretzels, cookies or brownies, carrots and cheese squares. Indicate which you prefer $2.00/person ____ or $4.00/person ____ and the day and time you would like them provided - _____morning or _____ afternoon (____Friday; ____Saturday; _____ Sunday)
Please note: If the final number of participants is less than the original number qiven, you will be responsible for paying for food/meals for the original number. (Please initial here indicating that you have read and understand this policy: _______)
Equipment provided in the conference room : TV/VCR/DVD, Projector Screen, Podium, Easels, Keyboard, Sound System. Please circle what equipment you will need and note below how you would like the conference room set-up: (e.g. round tables with chairs or just chairs set theatre style)
__________________________________________________________________________________________
__________________________________________________________________________________________
Please note: If your group is NOT meeting in the Bergland Conference room, we may not be able to offer some of the above mentioned equipment.)
Day Use Fee: For those participants attending during the day only, there is a charge of $10.00 per person per day plus any meals and/or activity costs . How many Day Use participants do you anticipate having_______.
Attendance Terms: We strive at Rockfish to be good stewards of this Center, so please reserve only the rooms you know you will use at the time of your retreat.
Deposit and Cancellation Policy: A 25% deposit is due with the return of this signed and completed ''Reservation Form.” We also need one signed page 4 of the Center's "Retreat Information, General Polices, and Agreements" returned with the reservation. Your deposit is nontransferable and will be deducted from the final balance, which is due prior to or during your event. In order to receive a refund of your deposit, less a $50.00 administration fee , you must submit your cancellation request in writing no less than twelve (12) weeks from your scheduled event. If you cancel between eleven (11) weeks and three (3) weeks prior to your event date , your deposit is nonrefundable . If you cancel anytime during the two-weeks prior to your event, you will be responsible for the full “Balance Due” (all meals and lodging expenses for the original number given.) Also, if the final number of participants is less than the original number given, you will be responsible for paying for the original number.
Please sign here noting that you have read and understand the above “Deposit and Cancellation Policy”
Signature : ______________________________ Printed Name :_____________________________
Please Note: Group leaders are responsible for sharing the "Rockfish Camp & Retreat Center's Retreat Information, General Polices, and Agreements" with participants prior to arrival. Rockfish reserves the right to place groups in meeting facilities best suited for the size of each group.
INCLEMENT WEATHER POLICY: If the Rockfish staff determines that conditions are unsafe, your group contact person will be notified at the earliest possible time. If the staff requests your group to cancel, a full refund of your deposit will be made. If your group makes the decision to cancel, the stated cancellation policy will be followed.
CAMP STORE: The Camp Store can be opened during your stay at your request to enable you to purchase a Rockfish keepsake. Prices range from $1.00 to $15.00.
Contract Activities: Please indicate on the reservation form which activities your group would like during your stay at Rockfish. If a day and time is not specified, our program director will schedule a time for you. (The Rockfish Outdoor Center will do its best to schedule events when requested.) Due to another group's needs, limited staff, and/or facilities available activities may have to be rescheduled. Please Note: During weekend retreats the following activities will be staffed between the hours of 1:00 to 5:00 pm on Saturdays only: swimming, archery, nature hike, and group challenge course. Please refer to the sheet entitled "Rockfish Outdoor Center Program Guide" for more information on any to the activities listed below:
Activity: Cost Time to Allow
______Campfire ($5.00/fire if staff builds) - 0 - (If you build your own)
______Archery (Min. 6 persons) $ 2.00 1 Hour
______Hayrides (Min. 10 persons) $ 2.00 1 Hour.
______Nature Hike (Min. 10 persons) $ 2.00 1 Hour
______ Low Ropes (aka Group Challenge Course) (Min. 10 persons) $ 8.00 2 Hours
______ High Ropes (min. 10 persons) $19.00 2 Hours
______Swimming (May-Sept.& min 20 persons) $ 4.00 2 Hours ______ Climbing/Repel Tower activities with 350 ‘ zip line $19.00 2 Hours ______ Horseback Riding (maximum of 5 people per session) $15.00 up to 90 minutes ______ Low Ropes & Tower Activities (min. 10) $23.00 2-4 Hours
Please read and sign: By my signature below, I represent that I am the person named above and that I have the authority and responsibility to represent my group and that I understand this agreement. Further, that I am responsible to ensure that Rockfish Camp & Retreat Center receives full and final payment. (An itemized bill will be provided upon request. The BALANCE is due prior to or during your event.) Furthermore, I have read and understand the Center's rates and attendance and cancellation policies.
Signature :____________________________________ Date:_______/_______/________
FORM OF PAYMENT: Credit Card: MC/Visa #:________________________________________
Exp. Date_______________ Three-digit code on back of card _________
Amount of Payment $___________________
Organization/Person's name on the card:___________________________
Print Name:___________________________________________
Check #____________Amount of Payment $_____________
A $25.00 FEE WILL BE CHARGED ON ALL RETURNED CHECKS
*Please make sure you have supplied the requested information on this form before returning to the Rockfish Camp & Retreat Center.
PLEASE NOTE: Your deposit may be forfeited if the Center facilities are not left clean and in order.
Please Note: Failure to return this reservation form along with the deposit and a copy of the signed agreements by
___/___/___will forfeit your reservation. If you have questions, please call the center at 910-425-3529.