RESERVATION FORM

SILVER BIRCHES RESORT "WHERE EVERY DAY IS A SATURDAY"

RESERVATION/RECEIPT/AGREEMENT FORM - SIGN AND MAIL TO 372 Queen St. S., Kitchener, Ontario N2G 1W7

Arrival Date:_________________, 2008 Departure Date:_________________, 2008

Name:______________________________________________________________

Address: __________________________________________________________Postal/Zip Code: _______________

Driver's Licence No.: ________________________________________________

Credit Card No: ___________________________________________________ Expiry Date: ________ /__________

No of Guests____ Cottage No.____ Preference: None:___1930's Rustic___ 1990's Wood Panel___Modern ____

SERIOUS MEDICAL/PHYSICAL CONDITIONS:_________________________________________________________

No of days: __________ x $ __________ per day (See Rate Page) _________ = $______________

Extras: Wood $_______ Linen $________ Propane: $_______ Pets $_______ = $ ______________

Taxes: add 10% (5% PST and 5% GST)________________________________ = $ ______________

TOTAL TO BE CHARGED TO THE ABOVE CREDIT/DEBIT CARD___________ = $ ______________

POLICIES
I consent to acknowledge and agree that: (1) in consideration of having a reservation at or staying at Silver
Birches Resort any credit/debit card or other information set out above may used to assist Silver Birches
Resort in providing additional services or promotional materials to me and in collecting amounts owing by
me from my credit/debit card providers and Moneris Solutions.; (2) any damage or loss to Silver Birches
Resort property, that is the result of my actions or the actions of persons or pets accompanying myself, or
the payment of lodging charges shall be paid for by myself from my above credit/debit card information and
Silver Birches Resort, in its sole discretion, shall be able to deduct, as my agent, the reasonable costs
of such repairs or replacement or payment of lodging charges from my above credit/debit card.; (3) Silver
Birches Resort shall have the absolute discretion from time to time to change my tentative rental reservation
spot with no notice on reservations less than a week and Silver Birches Resort may, in its absolute discretion,
make refunds of monies paid by me only if my reserved spot is re-rented for the same time period minus a 20%
administrative charge.; (4) I am entering Silver Birches Resort along with my guests and family members at my
own risk and I shall assume all responsibility for any liability for any loss or damage to my property or the
property of my guests or family members or any injury or death to myself, my guests or family members and
Silver Birches Resort or its owners or employees shall not assume responsibilty or be held responsible for any
such loss, damage or injury.; (5) I have explained the above policies to all those travelling with me.

GUEST'S SIGNATURE: __________________________________________________DATE: _____________, 2008

SILVER BIRCHES RESORT SIGNATURE___________________________________ DATE: _____________, 2008

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