Center for Adventure Learning - Application for use of Ketcham Woods by IWU faculty, staff or students ONLY

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Application for use of Ketcham Woods by IWU faculty, staff or students ONLY

* Indicates that field is required for form submission.

Organization: *

Contact Person: *

Mailing Address: *

City: *

State: *

Zip: *

Business Phone: *

FAX:

Contact Phone: *

Cell Phone:

Email: *

Reservation Dates: *

Arrival Time: *

Departure Time: *

Number of Participants: *

Nature of Activity: *

Population (type of group): *

Overnight: *
Yes
No

Number of Days: *

Electrical Needs: *

Insurance Company Name: *

Phone Number: *

Policy Number: *

I agree to the terms of this release of liability (below) *
I agree

(Submit Form 2 weeks prior to the event)

I agree to follow, and make all reasonable efforts to ensure that members of my group also follow, all relevant university rules and regulations including, but not limited to the following:

Refrain from use of rope initiatives and paintball field without certified IWU supervisors.
Clean up the property after use (carry-in, carry-out).
Park vehicles in designated area.
Build fires only in fire pits and not leave any fire unattended.
Not use fireworks, firearms, or any other potentially harmful apparatus.
Not move any structure or equipment.
Submit a plan (to be approved by IWU Staff) for any temporary structures and or sound equipment.
Be assessed for damages beyond normal wear and tear.
Not swim in the pond.
Have a 1 to 8 Adult to Youth/Teen ratio for supervision.

Lynette Bowsher, Director
Center for Adventure Learning
4201 S. Washington Street
Marion, In 46953
765.677.2749
FAX 765.677.2631
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