Rental Request Form

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141 Bancroft Private Dr., Kingsport, TN 37660

423-288-4532

Please be sure to read our Rules for Use of Camp Facility before filling out this form.

A non-refundable deposit of $50 is required to secure your rental, which will be applied to your total rental fee.

If you prefer to print out the rental request form, you can download it here.

CONTACT INFORMATION

CHURCH/ORGANIZATION INFORMATION

RENTAL INFORMATION

Dates of Occupancy:

**Please email proof of insurance to

SERVICES INFORMATION

Tilley Dining Hall

Tilley Dining Hall (Select ONLY one)

Dining Hall ONLY ($50/day)

Dining Hall w/kitchen {appliances & sinks} ($75/day)

Dining Hall with kitchen & dishwasher ($150/day)

Cabins

$10 per person per night. (All persons spending the night)

Select all cabins needed

Charity Cabin (sleeps 16)

Faith Cabin (sleeps 16)

Hope Cabin (sleeps 16)

Joy Cabin (sleeps 18)

Peace Cabin (sleeps 19)

Chapel

$25/day (no food or drink in building)

Select an option

Yes

No

Recreation Building

$25/day

Select an option

Yes

No

Grace Apartments

$25/night (extra $5/rm if using our towels & linens

Please select an option(s):

Room 1 (1 full, 3 twin)

Room 4-5 (kitchenette - $20 extra)

Room 6 (1 queen, handicap acc. bathroom)

Room 7 (1 queen, 2 twin)

Room 8 (2 queen)

Room 9 (6 twin)

I do not need any apartments

Outdoor Activity Fees

The use of these activities depends on weather and the availability of staff to run activities

**Outdoor Activity Fees are per person

Please select an option(s):

Climbing Tower ($5/person)

Tower Zip Line ($5/person)

Climbing Tower & Zip Line ($8/person)

Dry Slide ($5/person)

Forest Zip Line ($5/person)

Paintball ($8/person - includes gear and ammo)

Pools (Flat Fee of $50 - LIFEGUARD REQUIRED)

We will notify you if the date you have requested is available and your event has been approved.

I have read and agree to abide by the "Rules for Use of Camp Facility." I understand that my personal/ministry insurance will be the primary.

By typing your name below you agree to recognize this as your digital signature.

Thanks for submitting! You will be contacted by one of our representatives to confirm your request.

RENTAL REQUEST FORM