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Property Reservations Application

Your Equipment

Marine Landing Equipment Application

Reservation is:

Registrar Department 9525 Monte Vista Ave. Montclair, CA 91763

[ ] Approved

T (626) 677-2366 F (909) 624-7928

[ ] Not Approved

Complete and Return to the Registrar Department with all Applicable Fees Attn: Property Registrar

A copy of this form will be returned to you and marked above either “Approved” or “Not Approved” The returned application

form will be your only confirmation notice.

Name: ___________________________________________________ Troop #: _______________________________

Name of Organization (If Non-Girl Scout): ______________________________________________________________

Address: _________________________________________________ Phone #: ______________________________

Ye s

Dates of use for Marine Landing: __________________________ Has this Date been Confirmed:

Program Level (s): _________________________________________ Planned # of participants: ________________

Swimming:

Swimming is not allowed at Marine Landing. Troops may swim next door at the public swimming beach. Proper Safety-

Wise standards must be met with a certified lifeguard and proper ratio of adult watchers.

Certified Lifeguard:

Name:

__________

_ E Mail:

___________

Type of Certification: ___________________________ Organization: ______________________Exp. Date: ________

Boating:

Per person fee includes use of a boat, lifejacket, and paddles. When utilizing the boats at Marine Landing there must be

proper Safety-Wise standards with a certified lifeguard, a certified boating instructor, and proper ratio of adult watchers.

Date Requested: ____________ Time Requested: From: __________ (am/pm) To: __________ (am/pm)

# of Participants ________ x $8.00 = Total amount due: ______________

Certified Boating (Small Craft Safety) Instructor:

Name:

E Mail:

_____

Type of Certification: ___________________________ Organization: ______________________Exp. Date: ________

Certified Lifeguard:

Name:

E Mail:

_____

Type of Certification: ___________________________ Organization: ______________________Exp. Date: ________

Payment Information:

Cash

Check #__________ #__________

Credit/Debit:

Visa

MasterCard

Discover

Amex

Credit Card #: _______________________________ Exp Date: __________ Signature: __________________________

Total Amount Due for

Equipment:

$ _______________________

Please attach copy of the current certifications requested

GSGLA 8/13

Form Gsgla - Property Reservations Application Marine Landing Equipment Application Form

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