Registration Form
Rockfish Camp & Retreat Center
226 Camp Rockfish Rd. Parkton, NC 28371
l-910-425-3529
Fax: 910-875-6177•E-mail: tim@rockfishoutdoorcenter.orgDate: April 11-13 2008 Cost: $65 per person
Spring Fling begins on Friday with check-in between 7:30-9:00pm and concludes with worship on Sunday morning 11:00 am.
Name: ________________________ Name of Group:________________________
Street Address: ______________________________City:_____________________
State:____________ Zip:__________ Home phone: (____)___________________
Work Phone: (____)______________ E-mail_______________________________
Please tell us how many will be in your group: Number of Chaperones: _____ male _____ female
Number of Youth: _____ male _____ female
Payment Information
Retreat Cost: Youth $65 Adults $55
(Cost includes 4 meals and lodging)
Deposit due: __________ Total number of youth X $20 (non-refundable)
___ I have enclosed a check. Please make checks out to Rockfish Camp & Retreat Center
___ Please bill my credit card. MasterCard & Visa accepted
Please make checks payable to Rockfish Camp & Retreat Center or you may charge the registration fee to your credit card:
Card Number ___/___/___/___-___/___/___/___-___/___/___/___-___/___/___/___
Expiration Date: __/__
Please Circle: Master Card or VISA Cardholder's billing address:_______________________City:________________ State:________ Zip:_____________
I give permission for my credit card to be charged the amount of $______ (full payment of registration fee is required). I have read and understand the cancellation and refund policies as described in the information above.
Signature of cardholder:____________________________ Date:___ /___/___
(Authorized Signature Required)
Returned Checks : A $25 handling charge is made for returned checks.
Insurance: Illness or injury needing medical treatment will be the responsibility of the camper’s family insurance plan. Rockfish does carry secondary insurance up to $1,500.00. Any expenses incurred in excess of this amount will remain the responsibility of the injured person, his or her family.
For Office use only
Lodging ________________________________
Church ________________________________
Date Rec'd ______________________________
Amt __________________ Ck# __________________
From________________________________________
Open to All : All camps operated by the North Carolina United Methodist Outdoor & Camping Ministries, Inc. are open to everyone without regard to race, color, sex, national origin, religious preference or ability. Our outdoor ministry is committed to serving persons on an individual basis to provide a meaningful camp experience.Questions: contact us at 910.425.3529 or tim@rockfishoutdoorcenter.org