RESERVATION FORM
BERGLAND CENTER - DAY USE
ROCKFISH OUTDOOR CENTER
226 Camp Rockfish Rd., Parkton, NC 28371
Phone: (910) 425-3529 or toll free 1-866-762-3474 Fax: (910) 875-6177
Website: RockfishOutdoorCenter.org
E-mail: info@RockfishOutdoorCenter.org
Date of Application: ____/ ____ / ____ Name of Group/Organization:____________________________________
Person Submitting Application:________________________ Contact Person:___________________________
Address: ________________________________________City:_________________________Zip:__________
Fax: (____)________________E-mail Required:_______________________________________
Phone: Home( )________________ Work( )_______________________
Date(s) Requested: ____________________________________________________________________
Number of Persons to Attend: ______ Please indicate below breakdown of total number to attend by ages:
___Adult (18+) ___Sr. High Youth (15-18) ___Mid High (11-14) ___Elementary (less then 10 years)
RATE PER DAY: $16.00 per person/day PLUS $ 200.00/day facility-use fee
Minimum number of people: 20 • Maximum number of people: 100
A 25% deposit is required with the return of this completed form and will be deducted from your final bill.
Final payment is requested one week prior to the scheduled event.
Includes: Lunch, meeting space, use of TV/VCR/DVD, overhead projector and screen, speakers, amplifier, easel and podium.
Indicate if your group will want: _____ Breakfast @$8.00/person and/or $ _____ Dinner @ $9.00 or $18.00/person (Please indicate if you want the $18.00 dinner meal.)
Snacks: $2.00 or $4.00/person/snack. The $2.00 snack includes beverage, pretzels & cookies; The $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
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 scheduledevent. If you cancel between eleven (11) weeks and two (2) 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” (facility use fee and all meals 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 “Information, General Polices, and Agreements" with participants prior to arrival.
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. (Rockfish 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.
Activity (Minimum Required): ___ Cost: (per person) Time Allocated:
______Campfire ($5.00/fire if staff builds) - 0 - (If you build your own)
______Archery (Min. 6 persons) $2.00 1 Hour
______Canoeing (Min. 10 persons) NOT AVAILABLE 2 Hours
______Climbing /Repel Tower/Zip-Line $18.00 2 Hours
______Climbing Tower & Low Ropes Course (min.10) $23.00 2-4 Hours
______Group Challenge Course (Min. 10 persons) $8.00 2 Hours
______Hayrides (Min. 10 persons) $2.00 1 Hour.
______High Ropes Course (min. 10) $18.00 2 Hours
______Horseback Riding (maximum of 5 people per session) $12.00 up to 90 minutes
______Nature Hike (Min. 10 persons) $2.00 1 Hour
______Paddle Boats and Kayaking (Min. 10 persons) NOT AVAILABLE 2 Hours
______Swimming (May-Aug.& min 20 persons)$4.00 2 Hours ______Tubing (May-Sept. & min. of 10 persons) $3.00 1 Hour
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 and final payment is requested one week prior to your event.)
Signature :____________________________________ Date:_______/_______/________
FORM OF PAYMENT: Credit Card: MC/Visa #:________________________________________
Security Code (last 3 digits on back of card)_________________________
Exp. Date_______________ Amount of Payment $___________________
Organization/Person’s name on the card:___________________________
Print Name:___________________________________________
Check #____________Amount of Payment $_____________
Purchase Order #_________________ 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.
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.