Request Form For Use Of Mobile Climbing Wall

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Western Massachusetts Council, BSA - Request for Use of Mobile Climbing Wall
413-562-1041
Western Massachusetts Council, Suite 5, 1 Arch Rd, Westfield MA 01085 FAX:
Requests for use of the Council Climbing Wall should be completed and submitted a minimum of six (6) weeks prior to the
date requested. A minimum $100 to cover towing and Massachusetts inspection fees will be charged; determination of the
actual fee will be determined based on the nature of the event (eg, recruitment, non-BSA, fundraising, etc).
Do not advertise your event until confirmation is received that staff and equipment are available for your request.
Do not assume all requests will be granted. Besides equipment scheduling, volunteer BSA Climbing Directors/Instructors to
supervise and operate the wall and climbing program must be available.
Requestors are responsible for the following on the scheduled day of use:
1.
4-6 adults or older teens who will assist with harnesses, helmets, crowd control and safety spotting as
directed by the Climbing Directors/Instructors
2.
If requestor is a BSA unit, leaders are expected to be on-site during wall operational hours to perform
Scouting recruitment and interface with the public if this event is open to the public.
3.
A level open area 100 ft by 40 ft in size with vehicle access for the towing vehicle to deliver, position and
remove the wall. The area must be free of all overhead obstructions (wires, trees etc) for wall setup and away
from roadways, excessive noise or distracting environments.
4.
Drinking water and restroom facilities within reasonable distance from the site must be available.
--------
Complete the information below and submit it to the Council Service Center after making a copy for your records
---------
Please print legibly
PACK
TROOP
CREW #________ or non-BSA organization _____________________________________________
Date/Time wall is to be used: ____/____/____ from _________ to __________
Please list any unit BSA Climbing Instructors or belayers who will be available to staff your event and when
(entire time, or specific hours):
_______
Estimated number of participants
___________________________________________________________________
Contact Person
Cell:(
)
Phone: Day (
)
Evening:(
)
EVENT Address (we must have a street address) :
Street ______________________________________________________________
City_________________________ State_____
Zip______
Reason for requesting wall use (intended purpose- unit event, public recruitment, etc)_________________________
Will admission to event be charged: Yes No
Will climbers be charged:
Yes No
I have read and understand the requirements and limitations and that the Western Massachusetts Council
reserves the right to withdraw any confirmations.
Signed ______________________________________
Date________________
---------------------------------------------------------------
---------------------------------------------------------------
area below for council use only
date received: _______________
approved by______________________ date approved:________________
Requester notified on __________________________ by __________________________
Climbing Director in charge_______________________ Assistant Director________________________________
Additional climbing staff
State inspection request sent in on___________________________________
Rev 3/20012

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