Name of Group:

Contact Email:

Person in Charge:

Title:

Address:

Phone:

(H)

(B)

City:

State:

Zip:

Purpose of Event:

Arrival Date:

Time:

AM

PM

Departure Date:

Time:

AM

PM

Expected Attendance:

Men:

Women:

Boys:

Girls:

Facilities

Campsites

Dining Hall

Archery Range

Blackfoot

New Hope

Showers

Rifle Range

Seneca

Ute

O Pavilion

Athletic Field

Neyati

Crockett

Council Ring

Dining Hall Housing

Cherokee

Sioux

OA Lodge

Tower/COPE Course ***

Algonquin

Seton

Boating*

John Rule Lodge

Kickapoo

Beard

Swimming*

Iroquois

Boone

Chippewa

Ottawa

I am familiar with the Camp facilities. We will be responsible for the facilities that we use and agree to reimburse the Okaw Valley Council for all reasonable costs and expenses incurred on account of any loss or damage to said facilities and/or equipment. I further hereby represent and warrant that we shall furnish adequate and qualified adult leadership and supervision for each of the facilities our group has requested.

* Use of Aquatic Facilities (Pool, Waterfront, and/or Watercraft) - Our group shall be responsible for providing qualified supervision and lifeguard and shall conduct ourselves in a safe prudent manner.

** Must be approved by the Council COPE Committee prior to application for usage. See other notes on camp usage fee sheets.