Sporting Event LOWA Lake Beach Use Request Form

Name of Event:*

Date(s)/Time(s) of Event:*

Events must end by 3 PM

Purpose of Event:

Sponsor(s):*

Registration Fee:

Does Sponsor carry appropriate insurance policy(ies)?:*

Name of Carrier/Policy Number:*

Responsible LOWA Member (Name/Section # & Lot #/telephone #):*

Request use of the lake?:

Yes
No

If yes, which lake(s)?:

Keaton's (Little Lake)
Main (Big Lake)
Front Entrance Pond

If lake use is requested, please describe area(s) to be used: :

(for example, coves only, north end only, entire main body, shore only, combination of areas)

If beach use is requested, which beach(es)(name[s]):

Cumberland (Keton's Lake)
Clubhouse
Cornwallis
Edgemont
Harper's Ferry
Mt. Pleasant
Pleasant Grove
Ramsay
Skyline

Number of ADULT participants: :

Number of CHILD participants: :

Please indicate age range.

Will sponsor obtain signed waiver that will hold LOWA harmless:

[Waiver to be completed by parent(s)/guardian(s) of minors]

LOWA Members Only?:

Will all boats be LOW registered boats?:

If no, number of non-LOW registered boats (estimate):

Will all boats be covered by liability insurance as mandated by LOWA regulations? :

Person responsible for assuring that all participants are familiar with LOWA Use of Lakes Rules :

(Name/Section # & Lot #/telephone #)

Please describe arrangements planned for Security including times and locations requested :

Note: You must coordinate with Security no less than one week before the event.

Please describe arrangements planned for Medical Assistance:

You must enter your outside guests in TekContol at least 24 hours before your event.:*

Agree

This will help ensure your guests are properly processed through security access control gate.

OTHER: Please provide any other information that you think will help in evaluating this request. :

Applicant's Name:*

Phone number:*

Email:*