Basic Information

 Last Name:            First Name         

 Street Address:
 Street Address 2:
 City, State, Zip:  
Home Phone with  (area code)
Work Phone with  (area code)
Cell Phone with  (area code)

E-mail:

Driver's License: 
Car Lic.: 
Make/Model of Car: 

How many Adults (18 & up):
How many Teen (13-17 yrs): 
How many Children (7-12 yrs): 
How many Pet (s): 

Note: Maximum of 6 people per site.

Rig Type:    Tent    Pop-up   Trailer
                  5th Wheel    Truck Camper    Class A - MH
                  Class B - MH    Class C - MH   Trailer/camper Size (ft)

Specific information for this visit:

• When are you coming? (mo/day/yr)  format.

First Night:

Last Night: (Please enter your last night, not your check out date)

Note: Check-in time on arrival date is 2pm.
GUESTS MUST CHECK IN AT OFFICE BEFORE SETTING UP !!!!!!!

Departure time is 1pm on your depart date.

• What kind of site do you want?  -Select from below

A) Tenters, Pop ups, Truck campers, Smaller trailers,- Those of you who don't want sewer connections at the site normally will pick from the choices below. (Dump station is available.)            

Briars with H20/Electric (tent/pop-up only)

River Site with Electric (tent/pop-up only)

River Site No Electric (tent/pop-up only)

Glades Site No Electric (tent/pop-up only)

Meadows with H20/electric/sewer (trailers/MH/pop-up/campers only)

B)  Motor homes, Larger trailers - Those who want full hookups (electric, water and sewer) connections at the site normally pick from choices below.

        I'm driving a motor home   or

I'm pulling a trailer

        Neither of the above, but I still want a full hookup site.

        Please check one box from below:   

•     Here's how to send $20 deposit to hold my site.  

Mail a check for $20 so it arrives within 5 days from now. I understand you'll send a confirmation after you receive the deposit.

White River Valley, PO Box 106, Gaysville, VT, 05746

• Send confirmation to:

     snail- mail address shown above.