Girl Scout Council of the Mid-South


	Site Reservation Request (For Girl Scout Council of the Mid-South Troops/Groups)

Instructions

Sites may be reserved no more than four months prior to the date requested. Reservation not complete until payment received.
Service Unit Camporees & Events: A $100.00 deposit, which will be applied toward the final camp fee, must accompany the reservation form used for a camporee. At the time of reservation, a camporee must reserve all areas of the campsite they anticipate using. The final amount of camp fees must be paid when the camporee forms are submitted, four weeks prior to the event.
No refund will be given when any reservation is cancelled with less than four weeks notice. If the reservation is cancelled with more than four weeks notice, then a refund will be issued with a cancellation fee of $20.00 deducted.

Note: Girl Scout troops/groups will need to submit Traveling Troop/Camping Approval Request forms at least three weeks prior to camping/overnight trip and include who will be the first aider and the trained troop camper accompanying the troop.

Fields marked with an asterisk are required.*
Date of Application:*
Service Unit:*
Troop/Group #:*
Age Level:*	Br. Jr. Teen Girl Scout
#Girls:	#Adults:
Leader's First Name:*
Leader's Last Name:*
Home Phone:*
Work Phone:
Cell Phone:
E-mail:
Address:*
City:*
State:*
Zip:*

First Dates Choice:*	to
Second Date Choice:	to
Arrival Time:*
Departure Time:*

(Usage period: For camps - 2:00 p.m. to 2:00 p.m. next day; For Program/Training Center overnights - 4:00 p.m. to 11:00 a.m. next day. There is some flexibility on these arrival/departure times depending on bookings. Please let us know in advance if time flexibility is needed.)

Indicate desired facility and/or equipment below.
Yes No Our Girl Scout troop/group would like to request a Campsite Host to meet us upon arrival at Girl Scout Camp Annemeekee, Fisherville, Yataka or at the Girl Scout Program/Training Center. Note: A ranger will meet you at the entrance to Girl Scout Kamp Kiwani upon your arrival.

Fee Note: All fees on this form are for Girl Scout Council of the Mid-South Girl Scout member groups. There are different Schedules of Rental Fees For Campsites And Equipment for: - Girl Scout Groups From Other Councils & Other Youth Serving Organizations - Non-Girl Scout Groups

	Facility/Equipment	Dates Open	Capacity	Accommodations	Cooking	Bath	Fee for Girl Scout Groups**
Girl Scout Kamp Kiwani
	Unit 1	4/1-11/1*	16 people	4 person cabins/ no electricity	SUH/FP, E, R,OC	BH w FT, HWS	$30/night
	Unit 2 (handicap access)	4/1-11/1*	36 people	4 person cabins/ no electricity	SUH/FP, E, R,OC	BH w FT, HWS	$30/night
	Unit 3	4/1-11/1*	36 people	4 person cabins/ no electricity	SUH/FP, E, R,OC	BH w FT, HWS	$30/night
	Unit 4	4/1-11/1*	36 people	4 person cabins/ no electricity	SUH/FP, E, R,OC	BH w FT, HWS	$30/night
	Unit 5	4/1-11/1*	36 people	4 person cabins/ no electricity	SUH/FP, E, R,OC	BH w FT, HWS	$30/night
	Unit 6	4/1-11/1*	36 people	4 person cabins/ no electricity	SUH/FP, E, R,OC	BH w FT, HWS	$30/night
	Kitchen w/Dining Hall (camporees only)	4/1-11/1*					$50/day, $125/Weekend
	Dining Hall Only (handicap access)	4/1-11/1*					$30/day
	Ranch (experienced Jr., Cad.,Sr. only)	4/1-11/1*	25 people	5 person shelters/ bunk beds	SUH/FP, E, R		$30/night
	Ginny Lodge	YR	16 people	Bunk beds/Wood stove	K/E/R/OC	FT, HWS	$35/night
	Tent Sites	4/1-11/1*			OC	PL	$15/night
	Canoes with paddles/life vests						$5/day/canoe
	Archery Equipment (for Jr., Cad., Sr.)						$20/day/troop/group $50/day/event.
Girl Scout Camp Annemeekee
	Lodge	YR	30 people	Wooden Floor/ Mattresses/ Gas Heat/ Air Conditioning	K, FP, E,R, OC	FT, HWS	$50/night
Girl Scout Camp Fisherville
	Lodge (handicap access)	YR	30 people	Concrete Floor/ Mattresses/ Gas Heat	K, FP, E, R, OC	FT, HWS	$40/night
	Cookie Pavilion Tent Camping (Site 1)	4/1-11/1	20 people	Tent Camping	FP, E	FT	$15/night
	(Site 2)	4/1-11/1	20 people	Tent Camping	FP, E	FT	$15/night
Girl Scout Camp Yataka
	Lodge	YR	30 people	Wooden Floor/ Mattresses/ Gas Heat	K, FP, E, R, OC	FT, HWS	$40/night
	Unit 1 - Tent Site	4/1-11/1	40 people		SUH, FP	PL, S	$15/night
	Unit 2 - Day only with main lodge	4/1-11/1			SUH/FP	Use main lodge	No additional charge
	Sunrise Point Lodge - Day only with main lodge	4/1-11/1			FP/no E	Use main lodge	No additional charge
Girl Scout Program/Training Center (handicap accessible)
	Kitchen/ Overnight Area	YR	Overnight - 14, Theatre Style - 30, Schoolroom Style - 20, Banquet Style - 36	Linoleum Floor/ Mattress/Heat/ Air Conditioning	K, E, R, OC, DW, M	FT,HWS	$60/night or all day $40/4 hours or less
	Multi-Purpose Room (to expand overnight capacity with Kitchen /Overnight Area)	YR	Overnight 20	Linoleum Floor/ Mattress/Heat/ Air Conditioning Pull-Down Stage	Use Kitchen/ Overnight Area	FT, HWS	$40/night (in addition to fee for Kitchen/Overnight Area)
	Multi-Purpose Room	YR	Theatre Style - 80, Schoolroom Style - 48, Banquet Style - 72	Linoleum Heat/ Air Conditioning Pull-Down Stage	Use Break Room with E, R, Sink, DM	FT	$50/All Day $40/4 hours or less
	Conference Room	YR	Theatre Style - 42, Schoolroom Style - 30, Conference Style - 30	Carpeting Heat/ Air Conditioning	Use Break Room with E,R, Sink, DM	FT	$45/ all day $25/4 hours or less
	Cornelia Seward Park	YR (outside water spigot on 4/1-11/1)	60	Pavilion/Firepit,*** 2 Bridges, 2 Picnic Tables	OC, E	FT	$25/all day $15/4 hours or less
	8 Canoes/Trailer with paddles/life vests						$7/day/canoe
	Traveling Archery Equipment (for Jr., Cad., Sr.)						$30/checkout time of no more than 5 days

BH - Bathhouse CSH - Central Shower House DM - Drink Machine DW - Dishwasher E - Electricity FP - Fireplace FT - Flush Toilets HWS - Hot Water Showers
K - Kitchen M - Microwave R - Refrigerator OC - Outdoor Cooking PL - Pit Latrines S - Showers SUH - Screened Unit House YR - Year Round

Note:

* Except for resident camp season (approx. 6/1 - 8/15)
** For a wood fire, a fire permit/fee of $25 payable to City of Memphis must be paid at the council office two weeks prior to use. Charcoal fires require no permit.

Payment
Card Holder's Name:
Credit Card Type:	VISA MC
Credit Card Number:
Expiration Date:

You may submit form electronically by clicking submit or print and deliver to the
Girl Scout Council of the Mid-South
Mail: PO Box 240246, Memphis, TN 38124-0246
Deliver: 2715 Kirby Parkway, Suite 1
Fax: (901) 797-2183