COON LAKE COMMUNITY AND SENIOR CENTER
DOCK SPACE AGREEMENT 2010
Member #_______
Name__________________________________ Phone______________________
Coon Lake Address____________________________________________________________
Alternate Address and Phone____________________________________________
Dock Space #_________ Email Address_________________________
Agreement and adherence with the Coon Lake Community & Senior Center, Inc.’s Dock Space Rules and Regulations for 2010 (enclosed) is required. By signing this agreement, you agree to abide by all rules and regulations as stated.
The Coon Lake Community and Senior Center hereby grants the above named party(ies) the permission to use the dock space designated above for a period of one year from May 1st 2010 to May 1st 2011.
Your currentproof of insurance coverage (certificate)must be attached to this form when returned with annual membership dues. Your homeowner’s insurance company must be notified and requested to provide you with proof of coverage as most policies will not automatically extend liability beyond a certain distance from your owned premises. This should be made out to the Center at 182 Forest Road, Wyoming, MN 55092.
This agreement must be renewed annually to maintain your dock space privileges and is not transferable.
Signed__________________________________ Date_________________________
PLEASE NOTE: If colored Membership Agreement and Membership Form is not completed in full with proof of insurance & submitted by May 1st, dock space may be reallocated.
