RESERVATION FORM
FOR OVERNIGHT TREEHOUSE OR YURTS
**TREEHOUSES & YURTS DO NOT HAVE ELECTRICITY**

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

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: $8.00 per person/ per night

$2.00 per person (for those coming just for the day plus activity costs)

Minimum number of people: 8 • Maximum number of people: 34

A 20% deposit is required and will be deducted from your final payment.

Final payment is requested one week prior to scheduled event.

We wish the Center to prepare our meals: Yes / No (Circle One) Please list the meals you want Rockfish to prepare: ____________________
:

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 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 "Rockfish Camp & Retreat Center 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.

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.

NEED TO BRING: Personal bedding (sheets, blankets, pillows, sleeping bag) for a single bed, wash cloths, towels, and 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.

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 $___________________

Security Code (last 3 digits on back of card)_________________________

Organization/Person’s name on the card:__________________________

Billing Address: __________________________________________________________________________________________

Signature:________________________________

Print Name:___________________________________________

Check #____________Amount of Payment $_____________

Purchase Order #_________________ Amount of Payment $___________

*Please make sure you have supplied the requested information on this form before returning to Rockfish.

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

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