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MIDDLE SCHOOL MODGNIK REGISTRATION CONTRACT
September 5-7, 2025
Cost: $175/person
Additional t-shirts: $10/each
$50 deposit/person due with this form
When you click on your payment option, a field will pop up where you'll enter the number of spots you're reserving.
After clicking "submit," a credit card payment window will appear. If you're paying by CHECK, close out of your browser (X out of screen). Please make check payable to BLUE RIDGE PRESBYTERY and mail to 32 Southgate Ct., Ste. 101, Harrisonburg, VA 22801.
Name of Church
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Contact Person
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Address
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Street Address
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Evening Phone
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Email
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Please select payment option. If paying by credit card you will be charged a 3% service charge.
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TOTAL number of reserved spots (students AND leaders)
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TOTAL number of reserved spots (students AND leaders)
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Please read the following carefully. Your signature will constitute agreement to these terms:
1. HEALTH AND ACCIDENT INSURANCE: Covenant Presbyterian Church nor any other church will be responsible for any accident coverage for other churches. Each church group must inform their participants that there is no insurance coverage for their group for accident or illness.
2. REMOVAL OF UNAUTHORIZED PERSONS, SUBSTANCES OR PETS. Rockbridge and the
MODGNIK Retreat members reserve the right to remove from the premises unauthorized persons or substances that create a disturbance or otherwise fail to abide by the terms of this contract, the rules and regulations of the Rockbridge Retreat Center and the directions of Rockbridge staff and volunteers. Unauthorized substances include alcohol and drugs.
3. DAMAGE TO PROPERTY OR EQUIPMENT. It is agreed that payment will be made for all damages to the Rockbridge property and/or equipment beyond the scope of normal wear and tear. Buildings, grounds, and equipment will be inspected before your group departs, and you will be notified of any damages.
4. CLEANING PROCEDURES. It is the group leader's responsibility to ensure that Rockbridge is cleaned before the group leaves the premises. A cleanup list will be provided to cover areas that need to be cleaned. If Rockbridge is not cleaned properly, a cleaning fee will be imposed. Rockbridge will provide cleaning supplies (brooms, mops, and basic cleaning chemicals).
5. PAYMENT OF FEES. The final balance of all monies must be received by Covenant Presbyterian Church prior to or while on the retreat. A final review of all monies owed and received will occur before you and your group leaves Rockbridge, and such review will include lodging, food service, other contracted
services, damages, and miscellaneous fees.
6. PROGRAMMING. Rockbridge is not responsible for the scheduling or provision of recreational or program activities unless specifically requested. Rockbridge will provide qualified leadership for waterfront and ropes course activities.
I have read the above information and agree to abide by these terms. I understand that $5/person of my deposit money is both non-refundable and non-transferable.
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Total
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