RESERVATION FORM
FOR OVERNIGHT LOG CABIN
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: ___/___/___ 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 fifteen (15). Maximum number is thirty-four (30).
No. of Persons to Attend: ______ Please indicate below breakdown of total number to attend (maximum capacity 34 persons)
___Adult (18+) ___Sr. High Youth (15-18) ___Mid High (11-14) ___Elementary (less than 10 years)
RATES: $22.00 per person/night (Two or More Nights)
$26.00 per person (One-night stay)
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.
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 scheduledevent. (A $50.00 administration fee will be deducted from your deposit). 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 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 above “Deposit and Cancellation Policy”
Signature: ____________________________________ Printed Name:________________________________________
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.
Meals: 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.
Please indicate the meals your group will want: Friday: _______________________________________;
Please indicate how many vegetarians in your group ______?
NEED TO BRING : Personal bedding (sheets, blankets, pillows, sleeping bag) for a single bed, towels, personal toiletries.
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 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 NOTE: Your deposit may be forfeited if the Center facilities are not left clean and in order.
NO CHANGES should be made less than three weeks prior to your arrival.
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 or toll
free at 1-866-ROC-FISH or 1-866-762-3474.