Property Reservations Application Form

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Property Reservations Application
For Day Use / Overnight Use
Registration Department 9525 Monte Vista Ave. Montclair, CA 91763
T (626) 677-2366 F (909) 624-7928
Complete and return all forms with applicable fees to the Registration Department Attn: Property Registrar
It is the responsibility of the leader to review all pertinent information located on the GSGLA website prior to submitting this application form.
Any forms submitted incorrectly or without full payment will be returned to the leader without being processed.
Name: ___________________________________________________ Troop #: _______________________________
Name of Organization
: _______________________________________________________________
(If Non-Girl Scout)
Property Information:
Property Requested: 1
(If Applicable)
(If Applicable):
Date Requested: 1
Choice: From: _________ To: _________ 2
: From: _________ To: _________ 3
From__________ To: _________
Time Requested: From: ________________ (am/pm) To: ________________ (am/pm) (Check Policies/Procedures for Time Guidelines)
Type of Use: ______ Day Use ______ Indoor Overnight Use ______ Outdoor Overnight Use ______ Indoor/Outdoor Overnight Use
Reason for Meeting: _____Service Unit Event _____Training _____ Troop Event _____Troop Camping ____Other_________________
Troop/Group/ Private Party Contact Information:
Girl Scout Level:
____ Daisy
_____ Brownie
_____ Junior
_____ Cadette
_____ Senior
_____ Ambassador
Are all attending Girl Scout Members? ___ Yes ___ No
(If No, please refer to Insurance Requirements and submit required paperwork)
Is this event considered a money earning event? ___ Yes ___No
Is this reservation considered a special event? ___ Yes ___No
Expected Attendance:
Adults: _______________________ Children (Under 18 Years): ________________________
Responsible Person:
Name: _____________________________________________________________________
Address: ______________________________________City, State, and Zip _________________________________
Phone Number: Home (______) ____________________________ Cell: (______) ____________________________
Email Address: __________________________________________________________________________________
Certified in First Aid/CPR: (Name of Adult/ Class) __________________________________________ Date Taken: ______________
Overnight Training: (Name of Adult/ Class) _______________________________________________ Date Taken: ______________
Please read over the second page of this reservation form. Once you have read and agreed to the terms of use for this property
reservation please sign and date below.
Signature: __________________________________________________________ Date: __________________
Payment Information:
Credit Card Type:
Card #: _______________________________________________________
Site Fee Amt: _________________
Exp Date: ___________
C V V #:
Security Dep. Amt: _____________
Signature: ________________________________________________
For Office Use Only:
Key Mailed:_______________
Amt. Deposited:_______________
Confirmation Sent:_______________
Access Code Sent:______________
Fee Returned:_______________
Fee Retained: _______________
Revised 3.16


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