Camp Site Rental Agreement Form Camp Pioneer – Beverly, WV Contact InformationToday's Date* Date Format: MM slash DD slash YYYY Check-In Date* Date Format: MM slash DD slash YYYY Name of Guest or Organization:*Contact Person:*Position:*Mailing Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Primary Phone:*Secondary Phone:Email:* Preferred Method of Contact:*EmailPhoneMailVehicle DescriptionYear:*Make:*Model:*License:*Camp Site Rate Schedule:Primitive Campsites (Car or Tent Camping; No utilities) - $15/night Water & 30 AMP Electric Campsites - $25/night; $150/week; $550/monthly Water, 30 AMP Electric, & Sewer Hook Up - $25/night; $150/week; $550/monthly Water & 50 AMP Electric - $25/night; $150/week; $550/monthly *Camp Pioneer reserves the right to adjust the rates within 60 days.Special Requests:Camp Site Rental Rules: All campers must check-in, present a copy of valid drivers license and pay for the site prior to hooking up to utilities, unless the site is pre-paid. Free Wi-Fi is available. Cell phone service is available through US Cellular, AT&T, and Ntelos. Quiet Hours are enforced between 10 PM and 7 AM. No generator use during this time. No smoking at any time in any building. Pets must be kept contained at the camp site. Pets may not be left unattended. Clean up after pets and dispose of waste in trash cans. Sites are assigned on a first come, first served basis and taking into consideration type of hook-up and special requests such as access for disabled guests. Fires permitted in designated fire rings only. Fires may be restricted during certain seasons. Please check with the Camp Manager. Extended stays (beyond 7 days) require full water and sewage hook up. Firewood may be purchased from the Camp Caretaker or Camp Manager. Occupants must maintain the cleanliness of their site and ensure that all refuse is in its appropriate container. Absolutely no ATV's or off road vehicles permitted without appropriate RCPRB written permission. Background checks and random drug testing may be required for all applicants. For emergencies, contact 911. For the Camp Manager, contact (304) 621-3638. 100% Pre-payment is required to secure camp site rental. Cancellations must be received 7 days prior to the arrival date to avoid a loss of 50% of the rental fee. Cancellations must be submitted in writing to the Camp Manager. Make check payable to Randolph County Park and Recreation Board. FeesTotal Rental Fees:*Received By:*Paid By:*CashCheckCheck #*The Randolph County Park and Recreation Board, it's employees or board members will not be liable for injury, or personal articles, lost, damaged or stolen. Print Name of Renter*Signature of RenterDate Date Format: MM slash DD slash YYYY Camp Site Rental Agreement Randolph County Park & Recreation Board (RCPRB) Facility and Use Agreement Addendum to Contracts
