RESERVATION FORM
FOR OVERNIGHT TENT/RV CAMPING
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: ______ 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: $5.00 per person
$2.00 per person (for those coming just for the day plus activity costs)
Minimum number of people: 10
A 25% deposit is required with the return of this completed and signed Reservation form. Your deposit will be deducted from your final bill.
FINAL PAYMENT IS REQUESTED ONE-WEEK PRIOR TO, OR DURING, YOUR SCHEDULED VISIT.
We wish Rockfish to prepare our meals: Yes/No (Circle One)
Meals: $24.00/person/day for 3 meals (minimum 20 people)
Please indicate below the meals you wish Rockfish staff to prepare:
Meals:______________________________________________________________________________________
Group leaders are responsible for sharing the "Rockfish Camp & Retreat Center Retreat Information, General Polices, and Agreements" with participants prior to arrival. Rockfish reserves the right to place groups in facilities best suited for the size of each group.
CANCELLATION POLICY: Reservations may be cancelled if Rockfish is notified six (6) weeks prior to the
scheduled event. Your reservation deposit less a $25.00 administration fee, will be refunded. No refunds will be given
for cancellations made after the six week deadline. Deposits may not be transferred to another group or date.
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 you will be responsible for all fees associated with your event as noted on this form.
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 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 #:________________________________________
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.
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.