RESERVATION FORM
FOR DINING HALL DAY USE
ROCKFISH CAMP & RETREAT 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: ____ /___/____ Group Name:___________________________________________________
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
No. of Persons to Attend: ______ Adults (18 & older) _______ Adolescents (13 – 17)______
$100./Day Facility-Use Fee + $16.00 per person/Day
Minimum number of people: 15 • Maximum number of people: 50
A 20% deposit is required with the return of this completed form and will be deducted from your final bill.
Includes: Lunch, meeting space, use of TV/VCR, overhead projector and screen, easel and podium. Activities are available for a small fee per person (see reverse/attachment). Please indicate which (if any) activities you would like to schedule.
Indicate additional meal(s) your group will want: _____ Breakfast @ $9.00/per person (served at 8:00 a.m.)
_____ Dinner @ $9.00 or $18.00/person (served at 6:00 p.m.) (Please indicate if you want the $18.00 meal.)
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 time you would like them provided - _____morning or _____ afternoon.
Group leaders are responsible for sharing the Center’s “Retreat Information, General Policies, and Agreements" with participants prior to arrival.
Deposit and Cancellation Policy: The deposit is due with this completed and signed "Reservation Form.” Your deposit is nontransferable and will be deducted from the final balance. In order to receive a refund of your deposit your cancellation request must be submitted in writing no less than twelve (12) weeks prior to your scheduledevent. (A $50.00 administration fee will be deducted). If you cancel less than six (6) 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 anytime within 10 days prior to your event, you will be responsible for the full “Balance Due.”
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 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 (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 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:___________________________
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 Outdoor 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.