CENTRAL N.C. COUNCIL

BOY SCOUTS OF AMERICA         

                                                           CAMP JOHN J. BARNHARDT

                      SPECIAL ACTIVITY USAGE PERMIT FOR NON-SCOUTING GROUPS

ORGANIZATION/GROUP NAME:  ___________________________________________________________

DATE(S) OF ACTIVITY__________________________ # OF INDIVIDUALS ATTENDING  ____________

TIME OF ARRIVAL____________________________TIME OF DEPARTURE________________________

PERSON RESPONSIBLE: NAME: __________________________________PHONE: __________________

ADDRESS: _______________________________ City __________________ State _______ Zip  __________

DESCRIBE EVENT TO BE HELD:

__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

INDICATE SPECIFIC USES OF FACILITY: (INSIDE/OUTSIDE): ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

I/We understand the undersigned are personally and/or the organization which I/We represent are responsible for any and all property damage or missing  property during contract hours and understand the Central N.C. Council and Boy Scouts of America assumes no liability for any accidents or sickness which may occur while on council property.

 _________________________________________________________   _______________

Signature of event  host or organization representative                             Date

The following facilities will occur charges as follows:

*Dining Hall                                          $300.00 per day                         _____________

*Dining Hall Kitchen

(refrigerator / freezer and prep area $50.00,  gas stoves/ovens $50.00)      _____________        

Rappelling Tower                                  $50.00 per ½ day                       _____________ (+ cost of BSA certified instructor)

Chapel Use                                           $100.00 per day                         _____________

O.A. Lodge                                          $ 70.00 per day                         _____________

Health Lodge                                        $ 50.00 per day                         _____________

Waterfront  (Canoes/Row Boats)           $ 10.00 per boat                                    _____________

Montgomery Lodge                               $ 50.00 per day                         _____________

Staff Lounge                                         $ 50.00 per day                         _____________

Cabins                                                  $ 30.00 per day                         _____________

Rifle/Shotgun Ranges                            $ 25.00 per day ea.                    _____________

(must provide own guns and certified instructors/certificates)                                            

Campsites – includes use of shower facilities     $ 10.00 per day per person         _____________

Swimming Pool                                     $500 min. charge up to 2 hrs.                         _____________ (+ cost of B.S.A. Lifeguard @ $17.50 /hr)

Contact Scout Executive for cost and approval.                                                   $50______ SECURITY DEPOSIT

TOTAL FEES……………………………………………___________

Note: A security deposit of $50.00 is required for use of Camp and must accompany this application to reserve any camp facility.  (This deposit will be refunded after party departs and leaves camp in order in which it was found.)           

All visitors to the camp MUST  check in with the camp ranger before entering camp.  No alcoholic beverages allowed on property.  All Council and National, BSA policies must be followed.

Council Scout Executive Approval __________________________________________Date_______________________

* Payment in Full must be received at least 10 business days in advance to hold reservation.