
| HBCA Hillcrest Baptist Camp-Assembly, Inc. Web Reservation Form R.F.D. 1, Box 254-A Cave in Rock, IL 62919 Phone: 618-289-3036 EVENT DATE:_____________ TODAY'S DATE:___________ ORGANIZATION NAME:__________________________________________ MAILING ADDRESS:_____________________________________________ CITY:__________________________ STATE:_________ ZIP:____________ PHONE:_________________ CONTACT PERSON:_____________________ CELL:________________FAX:______________EMAIL:_________________ RESERVATION: On confirmation of a deposit of $_________(AMOUNT) due within ten (10) working days for________( # OF PEOPLE) reservations for: ARRIVAL DATE:______________ DEPARTURE DATE:__________________ ARRIVAL TIME:______________ DEPARTURE TIME:___________________ KITCHEN:_______ FIRST MEAL__________ LAST MEAL________________ GROUP WILL BE COMPOSED OF: Children______Youth_____Men______ Ladies________ Mixed Adults_______ USE OF TABERNACLE__________ THIS FORM MUST BE COMPLETELY FILLED OUT & ACCOMPANIED WITH DEPOSIT FOR THE EVENT TO BE CONFIRMED! BALANCE OF INVOICE IS DUE BY CLOSE OF THE EVENT. I UNDERSTAND THAT ACCORDING TO ILLINOIS STATE REGULATIONS WE NEED CAMP GROUP LEADER____, ILLINOIS CERTIFIED NURSE & COOK____. LEADER'S PLANNING GUIDE & ABOVE STATEMENTS HAVE BEEN READ & POLICIES WILL BE ADHERED TO BY OUR GROUP._______________________ SIGNATURE OF GROUP LEADER YOU HAVE 10 WORKING DAYS TO GET THIS FORM & REQUIRED DEPOSIT BACK TO US. AFTER THAT TIME, THE DATE WILL BE OPENED TO OTHER GROUPS THAT MAY BE WAITING. SIGNED:____________________________________DATE:_____________ PASTOR OR PERSON AUTHORIZED TO MAKE COMMITMENT SIGNED:____________________________________DATE:_____________ GROUP LEADER |
| Please fill out this form |