**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 Reservation Application to:
Bill & LaVerne Blickley
1312 Dunham S. E.
Grand Rapids, MI   49506
(616) 452-2683
email: blickley@altelco.net
Make sure to keep a copy for your own records.

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

Leader's Name Organization Date

Leader's address    Leader's Cell Phone #   

Leaders email address     Organization's email address 

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:  Four (3pers) tents available, # requested:  Number needing bus: 
 

Reason (4 max.) requesting special inside bus sleeping accommodations:

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

 We will provide liability releases, and a co-insured certificate from our insurance company: Yes ,  No


Send the following Adult Leader liability releases at least 7 days before the outing: Click here for the release

Send the following Parent/Guardian liability releases at least 7 days before the outing: Click here for the release

Send a copy of a Liability co-insurance certificate at least 7 days before the outing: Click here for a sample certificate


Youth group Leaders Signature:          Date  

          If you're going to email this reservation application, this signature may be typed in, otherwise the leader's signature should be hand written.

 

After typing the information into the form above, you can: 
Use Windows Screen Capture Tool to copy this form to your (Microsoft Word?) program and send via US mail.
Or...capture it with the screen capture tool and past it into your an email message and email it to blickley@altelco.net
Mail it at least 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