| Address:
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City:
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| State:
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Zip:
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| Phone Res:
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Phone Bus:
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Email:
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| No. Attending Youth:
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Adult:
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Total:
(Limit 150 people total) |
| Facilities Requested: Check all that apply. * Denotes Occupancy limits. |
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Bailey's Cross Roads Host Cabin (14)* |
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Durant Hall (49) * |
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Fauquier/Herndon Cabin (20)* |
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Park West Cabin (20)*(Under Construction) |
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Tent Camping Area # 1 |
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Vienna Host/Engleside Cabin(18)* |
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Vienna Host Primitive Area # 2 |
| Our insurance requires that you provide a copy of your "tour permit"/council authorization for scouts; certificate of insurance for other groups. This needs to be in the hands of the camp scheduler before your request can be confirmed. |
- Use of the camp requires a $100 refundable security deposit. Use of the camp and Durant Hall with kitchen requires a $200 refundable deposit, which must accompany your reservation. The security deposit will be refunded after the camp has been inspected by the caretaker and at the discretion of the Camp Board. Separate checks should be mailed to the scheduler.
- Fee Schedule:
- Friday and Saturday nights $5.00/camper/event.
- Sunday through Thursday or more than 2 nights of camping $5.00/person/night.
- Use of Durant Hall with the Kitchen $100/week for more than 2 nights of camping
- Separate checks should be mailed to the scheduler.
- There must be at least one adult (over 21 years of age) in each cabin.
- No cooking of any kind is allowed in any of the cabins. Cooking is to be done outside in the permanent fire pits, on approved stoves or in the Durant Hall Kitchen. Firewood is all around you. Downed, dead trees may be used for fires. Do not cut any live trees!!
- Keep the bathhouse doors closed at all times. Snakes and unwanted animals may enter. Close doors for your safety. The bathhouse needs to be left in a clean condition.
- Do not move bunks within the cabins so that exit doors are blocked. All doors must be kept unblocked.
- All doors and windows should be left closed and all lights and heat turned off in all building when you leave. This includes all facilities that you used. (cabins, bathhouse, Durant Hall and the pavilion). All thermostats in the cabins should be set to "off".
- Electric outlets are for lighting, not electronic equipment. (Except in Durant Hall which is wired to handle additional equipment.)
- The camp will be inspected after you leave. Any problems will be reported to the camp board and could affect your group's future use of the camp, and/or your security deposit may be forfeited and you will be billed for repairs.
- No smoking in the cabins or Durant Hall.
- No alcohol or firearms are permitted on the camp property.
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| I have read and understand the above rules of the Northern Virginia Lions Youth Camp, Inc. and agree to these rules. I will be in attendance at the Northern Virginia Lions Youth Camp, Inc. and will be responsible for the youth and adults present. Further, as the authorized representative of the organization using the facilities and grounds of the Northern Virginia Lions Youth Camp, Inc. (also referred to as the Youth Camp), I agree that my organization shall indemnify and hold harmless and defend the Youth Camp, its members, officers, employees and authorized representative against any liability for any suits, actions or claims for injuries or damages of any character arising from or relating to the use by my organization or its employees, agents or representatives of the land, improvements or facilities of the Youth Camp. |
| Organization's Representative Sign & Date: _________________________________________________ |
| Organization's Representative Type or Print Name:
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Print and mail with checks to: NORTHERN VIRGINIA LIONS YOUTH CAMP, INC. |
| % Nancy Hetzel, Scheduler |
| 865 Smith Rd, Charles Town, WV 25414-4634 |
| FAX: 304-725-5088;
E-mail: nvlyc@yahoo.com |