Girl Scout Council of the Mid-South

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

Instructions
  1. Sites may be reserved no more than four months prior to the date requested. Reservation not complete until payment received.
  2. 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.
  3. 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