ROCKFISH CAMP & RETREAT CENTER
226 Camp Rockfish Rd., PARKTON, NC 28371
Phone: (910) 425-3529 or toll free 1-866-762-3474 Fax: (910) 425-8665
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:____________________
Phone: Home( )_____________ Work(___)________________
Dates Requested: From:____________________ to __________________________
Arrival Time ________ Departure Time__________
No. 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: $ 3.00 per person
Minimum number of people: 20
The following deposit is required and will be deducted from your final bill:
$20.00 for One Day or $40.00 for Two or More Days
Group leaders are responsible for sharing the "Rockfish Outdoor Center Retreat Information, General Polices, and Agreements" with participants prior to arrival. Rockfish Outdoor Center reserves the right to place groups in lodging facilities best suited for the size of each group. All information on this page is subject to change at any time, including the rates.
Meals (minimum 20 people): Meal costs are $22.00/person/day for three meals; $15.00/person/day for two meals; and, $8.00/person/day for one meal. Please indicate which meals you want the Center to prepare for your group: _________________________________________________________________________________________.
Deposit Amount: A 20% deposit is required and will be deducted from your final bill. 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 $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 the original number. If you cancel anytime during the two week period prior to your event, you will be responsible for the full “Balance Due” (all 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:________________________________________
INCLEMENT WEATHER POLICY: If the center staff determines that conditions are unsafe for groups to occupy
the center the group contact person will be notified at the earliest possible time. If the center staff requests your group
to cancel, a full refund of your deposit will be made. If your group makes the decision not to come, the cancellation policy
will be followed.
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: __ Time Allocated:
______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
______Canoeing (Min. 10 persons) NOT AVAILABLE 2 Hours
______Paddle Boats and Kayaking (Min. 10 persons) NOT AVAILABLE 2 Hours
______Group Challenge Course (Min. 10 persons) $8.00 2 Hours
______Swimming (May-Sept.& min 20 persons)$4.00 2 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 Outdoor Center receives full and final payment. An itemized bill will be provided to you before you leave the
facility. Balance is due prior to your event or prior to departure. Furthermore, I have received and understand the rates for
lodging and the Center's attendance and cancellation policies.
Signature :____________________________________ Date:_______/_______/________
FORM OF PAYMENT: Credit Card: MC/Visa #:________________________________________
Exp. Date_______________ Amount of Payment $___________________
Organization/Person’s name on the card:__________________________
Print Name:___________________________________________
Check #____________Amount of Payment $_____________
Purchase Order #_________________ Amount of Payment $___________
If you are paying by credit card or purchase order and would like to fax us the information our fax # is (910) 425-8665.
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.
NO CHANGES should be made less than four 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.