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Long Island Park Camping Permit

  1. Name of Responsible Party

  2. Please list the full names of all persons who will be staying on your camp site

  3. Please list the license plate number of the vehicle that will be on the park

  4. CCRD Camping Policy*

    By checking the "I agree" box below, you agree that you have reviewed and agree to adhere to the following policies: 1. Park Hours-7:00 A.M. to 9:00 P.M. The park is open from 7:00 A.M. to 9:00 P.M. daily except by special permit. 2. Park facilities may be reserved by filling an application and processing a permit with the Department of Recreation, P. O. Box 369, Rustburg, Virginia 24588. Permits may be carried and produced upon the request of an authorized County Personnel. 3. All activities and facilities not requiring a permit will be available to the public on a first-come, first-served basis. 4. Fires may be kindled only in grills and fireplaces provided in the park, or in private grills. 5. Alcoholic beverages and illegal narcotics are prohibited on park property. 6. Motorized vehicles are prohibited in the park except on roadways and paring areas. 7. All pets shall be kept on a leash while in the park. 8. It shall be unlawful for any person to kill any bird or animal within the park. 9. The amplification of music, speeches or any other sound within the park is allowed only upon written permission from the Director of Recreation. 10. The Campbell County Sheriff’s Office will enforce all state and local laws in the park. 11. Pavilions may be reserved by groups of 25 persons and up. One pavilion will always be on a first come, first served basis. There will be a $25.00 deposit made by check payable to County of Campbell with the reservation. The deposit will be forfeited if the group fails to show up at the reserved time or if there is a major little or vandalism problem occurring during the reserved time; otherwise, the check will be returned to the group. 12. Reservations will be taken on a Park Use Permit form. No reservations will be taken over the phone. 13. The Director of Recreation or the County Administrator shall have the authority to revoke a permit upon finding a violation of any rule, ordinance, state law, condition of the permit or upon good cause shown. 14. No selling or vending of food, drinks, or other objects shall be allowed in the park except by special permission from the Director of Recreation or the County Administrator.

  5. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

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  7. This field is not part of the form submission.