RESERVATION FORM
FOR OVERNIGHT CABIN

All Rates Are Based Per Person

ROCKFISH CAMP & RETREAT CENTER
226 Camp Rockfish Rd., PARKTON, NC 28371

Phone: (910) 425-3529 or Fax: (910) 875-6177
Website: RockfishOutdoorCenter.org
E-mail: info@RockfishOutdoorCenter.org

Date of Application: ___/___/___ Name of Organization/Church:____________________________________________

Person Submitting Application:___________________________ Contact Person:______________________________

Address: _____________________________________________City:_________________________Zip:_________

Fax: (_____)_________________E-mail Required: ____________________________________________________

Phone: Home: (____)_____________________________ Work: (____)-___________________________________

Dates Requested: From:_________________________________ to ______________________________________

Date Arrival Time Date Departure Time

Minimum number required to reserve this facility is eight (8). A-frame Cabins have two sides with separate entrances and they sleep either 8 or 10 per side.

No. of Persons to Attend: ______ Please indicate below breakdown of total number to attend (maximum capacity 108 persons)

Adult (18+) Male ___ Female ____; Sr. High Youth (15-18) Male ____ Female ____; Mid High (11-14) Male ____ Female _____; Elementary (less than 10 years) Male ____ Female ____

RATES: $18.00 per person/night (Two or More Nights)
$22.00 per person (One-night stay)

One meeting space will be provided for a group of 25 or more. Additional meeting space may be provided (depending on availability) @ $100. per space per day.

Deposit Amount: A 25% deposit is required and will be deducted from your final bill.

Final payment is requested prior to, or during, your scheduled visit.

Meals are $24/person/day for three meals; $16/person/day for two meals; $9/person for one meal. We also have a “plate-served” $18.00/person prime rib meal (with an option of turkey, ham or chicken breast for people not wanting prime rib) served with vegetables, tossed salad, rolls, dessert, and beverages.

Please indicate the meals your group will want: Friday : _______________________________________;

Saturday: _____________________________________; Sunday: ______________________________; Monday______________________________________; Please indicate if your group would like the $18./person meal: ________, if so/when _______________ ?

Please indicate the number of vegetarians in your group ______?

Deposit and Cancellation Policy: The deposit is due with this completed and signed "Reservation Form" and a signed copy of page 4 of the Center's "Retreat Information, General Policies, and Agreements." 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 (if you cancel) you must submit your cancellation request in writing no less than twelve (12) weeks from your scheduled event. (A $25.00 administration fee will be deducted from your deposit). If you cancel between eleven (11) weeks and three (3) weeks from your event date, your deposit is nonrefundable. Also, if the final number of participants is less than the original number given, you will be responsible for paying for food/meals for the original number. If you cancel less than 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.)

Please sign here noting that you have read and understand the aforementioned “Deposit and Cancellation Policy”

Signature: ____________________________________ Printed Name:___________________________________

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 you group makes the decision to cancel, the stated cancellation policy will be followed.

Please Note: Group leaders are responsible for sharing the Center's “Retreat Information, General Polices, and Agreements" with participants prior to arrival. Rockfish reserves the right to place groups in lodging facilities best suited for the size of each group.

NEED TO BRING : Personal bedding (sheets, blankets, pillows, sleeping bag) for a single bed, towels, personal toiletries.

CAMP STORE: The Camp Store may 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 any three 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, and nature hike.

*If you are interested in additional time call for prices.

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 receives full and final payment. An itemized bill will be provided upon request and the Balance is due prior to or during your event. Furthermore, I have received and understand the Center's rates, attendance, and cancellation policies .

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:__________________________

Billing Address: _________________________________________

____________________________________________

Signature:________________________________

Print Name:___________________________________________

Check #____________Amount of Payment $_____________

Purchase Order #_________________ Amount of Payment $___________

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.

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