NORTHERN VIRGINIA LIONS YOUTH CAMP, INC.

REQUEST FOR USE APPLICATION
Name of Organization: NVLYC email

Arrival Date:

Departure Date:

Year
Sponsoring Organization:
Event Type:
Onsite Person in Charge Name: Event Type:
(This person to be on site during the entire event and will be sent the confirmation.)
Phone Res: Cell/Bus Phone:
Email:  

Organization's Responsible Person:

Address:

City:

State:

Zip:

Phone Res:

Phone Bus:

Email:

No. Attending Youth:

Adult:

Total: (Limit 150 people total)

Facilities Requested: Check all that apply. * Denotes Occupancy limits.

Amphitheater

Bailey's Cross Roads Host Cabin (14)*

Clifton Cabin (22)* Separate room Sleeps 2 Adults

Durant Hall with Kitchen (49) *

Park West Cabin (20)*Separate room Sleeps 2 Adults

Pavilion

Fairfax Host Cabin (12)*

Tent Camping Area # 1

Tent Camping Area # 2

Tent Camping Area # 3

Vienna Host Cabin(18)*

Warrenton Sunrise Cabin (8)* OUT OF SERVICE USED FOR STORAGE

Woodbridge Cabin (20)*

 

Our insurance company requires that you provide a copy of a "Certificate of Insurance". This needs to be in the hands of the camp scheduler before your request can be confirmed. The user's fees must be in the hands of the camp scheduler one week before the start date of your event.

Family pets are not permitted on the Northern Virginia Lions Youth Camp, Inc property. Service animals are permitted.

User/Camping Fee Schedules:

  1. Use of the camp requires a $100 refundable security deposit. The security deposit will be refunded/forfeited. Refunded if no destruction is incurred at the camp. Forfeited if destruction is incurred at the camp. The caretaker will inspect the camp after the outing and report the finding to the camp board for their decision. The security deposit will be applied to the camping fee if not damage is done to the camp.
  2. Use of Durant Hall with kitchen requires a $100 security deposit, which must accompany your reservation. The security deposit will be refunded/forfeited. Refunded if no destruction is incurred at Durant Hall. Forfeited if destruction is incurred at Durant Hall. The caretaker will inspect Durant Hall after the outing and report the finding to the camp board for their decision.
  3. Use of Durant Hall with the Kitchen rental fee is $100.00. The security deposit came will be applied towards the rental if not damage to Durant Hall.
  4. Friday and Saturday nights $5.00/camper which includes for both Friday and Saturday. Starting with booking as of January 1, 2020 camping fees will increase from $5.00 for Friday and Saturday nights to $5.00/person/night.
  5. Sunday through Thursday or more than 2 nights of camping $5.00/person/night. Starting with booking January 1, 2020 camping fee will be $5.00/person/night

I have read and understand the above rules of the Northern Virginia Lions Youth Camp, Inc. and agree to these rules. I will be in attendance at the Northern Virginia Lions Youth Camp, Inc. and will be responsible for the youth and adults present. Further, as the authorized representative of the organization using the facilities and grounds of the Northern Virginia Lions Youth Camp, Inc. (also referred to as the Youth Camp), I agree that my organization shall indemnify and hold harmless and defend the Youth Camp, its members, officers, employees and authorized representative against any liability for any suits, actions or claims for injuries or damages of any character arising from or relating to the use by my organization or its employees, agents or representatives of the land, improvements or facilities of the Youth Camp.

Note: The day before your scheduled visit to the Youth Camp notify the camp scheduler with the number of campers attending your event.

Organization's Representative Sign & Date: _________________________________________________

Click here for instruction to save this file as a pdfThe email address has changed. NOTE: New fee schedule starting January 1, 2020 is $5.00 per person per night.

Organization's Representative Type or Print Name: __________________________________________

Print and mail with checks to: NORTHERN VIRGINIA LIONS YOUTH CAMP, INC.

% Phil Schrack, Scheduler

3568 Sutherland Court, Warrenton, VA 20187 3971

E-mail:NVLYCI@gmail.com

November 2, 2020