shelter house resv. form

MOHICAN STATE PARK

SHELTER HOUSE RESERVATION

1. This application must be submitted directly to the Park Office with a check for the entire reservation fee for $50.00 payable to

Mohican State P= ark for approval. If the application is approved you= will receive a confirmation letter and receipt.

&nbs= p;

2. Approval of this application will authorize the applicant to use the shelter house for the requested date at = the designated area only.

&nbs= p;

3. All State Park rules and regulations will be adhered to or the permit will be canceled. Alcoholic beverages are prohibited= on State Park grounds. Parking is permitted in designated parking lots only. = &nb= sp; = &nb= sp;

= &nb= sp; = &nb= sp;

4. All activities of the applicant sh= all be at their own risk. The applic= ant agrees to indemnify and hold harmless the State of <= st1:place w:st=3D"on">Ohio and its assigns for the loss of l= ife, personal injury or property damage arising from the use of the shelter house. The applicant is respo= nsible for the removal of all personal property. = &nb= sp; = &nb= sp;

&nbs= p;

5. Applicant must be at least 18 year= s of age to rent a shelter house.

&nbs= p;

6. Cancellation must be made in writi= ng at least 15 days prior to the reservation date for a full refund.

&nbs= p;

7. Call the Park Office if you have questions, or to inquire about dates or shelter houses that are available at 419-994-5125.

&nbs= p;

7. Make checks out for $50.00 payable= to Mohican State Park and mail to: Mohican= State Park

= &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; ATTN: Park Secretary

= &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; 3116 St. Rt. 3<= /b>

        =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;     Loudonville,= OH 44842

8. Designate which shelter house you = are requesting with a check mark:

     (   ) Class “A” Picnic Shelt= er House. Near St. Rt. 3 and the Clear Fork River, electric outlets, playground,        =             &nb= sp;

        =             &nb= sp;            =             &nb= sp;            =             &nb= sp;   flush restroom, and drinking fountain.

     (   ) South Park Shelter House. At the Gor= ge Overlook, no electric outlets, no water, pit latrine, and

        =             &nb= sp;            =             &nb= sp;            =      ADA accessible. This area is clos= ed at sunset.

     (   ) North Park<= /st1:place> Shelter House. On the sam= e road as the State Forest office, pit latrine, no ele= ctric, no water,

        =             &nb= sp;            =             &nb= sp;            =       and has stone fireplaces on both ends of the shelter house.

&nbs= p;

&nbs= p;

DATE SHELTER HOUSE REQUESTED: _________________        =             &nb= sp;            =            AMOUNT ENCLOSED _________________

WHAT DO YOU WANT THE “RESERVED BY” SIGN TO SAY: ____________________________________________________= ___

APPLICANT’S NAME: ___________________________________________________________________________= ____________

ADDRESS: ___________________________= ______________________________________________________________________=

        =             &nb= sp;            =             &nb= sp;            =             &nb= sp;     STREET        =             &nb= sp;            =            CITY        =             &nb= sp;                   = STATE        =             &nb= sp;        ZIP CODE

PHONE NUMBER: ____________________________________

APPLICANT’S SIGNATURE: _________________________________________________________________

        =             &nb= sp;            =             &nb= sp;            =            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =       DATE

&nbs= p;

&nbs= p;

&nbs= p;

&nbs= p;

&nbs= p;

&nbs= p;

&nbs= p;

&nbs= p;

&nbs= p;

        =             &nb= sp;            =             &nb= sp;