**Reservation Application**

Supporting youth groups from the Grand Rapids Area
A volunteer service for groups with members from lower income families

Since 1994


This support opportunity to  youth groups is completely volunteer with no fee charged 

Your group leaders are responsible for programming, cooking, and the supervision of their group members. 

Print, fill out and email or US Mail this page to:
Bill & LaVerne Blickley
1312 Dunham S. E.
Grand Rapids, MI   49506
(616) 452-2683

Make sure to keep a copy for your own records.

Leader's Name ____________________ Organization ______________________________ Date _______

Leader's address __________________________________________ Leader's Phone #________________

Organization's Address _________________________________ Organization's Phone #_______________

Emergency Organizational Phone #______________ Emergency Organizational Cell Phone # ____________

Number of days for outing: ________  Dates for outing: Beginning ______________ Ending____________

Number of people in outing: ________ Number of people (8 maximum) requesting inside bus sleeping accommodations:_____

Some of the group members are from lower income families. Yes ___,  No ___

Send your reservation at least 14 days in advance of your wish to camp here.

Please Use Windows Screen Capture Tool to copy this completed form to your email,
or print it
and mail it 14 days in advance to: Bill and LaVerne Blickley, 1312 Dunham SE, Grand Rapids, MI. 49506
To use Screen Capture tool: On your computer click All Programs, Accessories, Screen Capture Tool 

email: blickley@altelco.net

Youth group Leaders Signature: __________________________________ Date_________________________