Application for Use of Brandwein Nature Learning Preserve by Groups, Schools and Organizations

Application for Use of Brandwein Nature Learning Preserve

By Groups, Schools, and Organizations

   

Name of Group, School, or Organization: ____________________________________________

Grade Levels and Ages of Students: ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­________________________________________________

Number of Students and Adults: ___________________________________________________

Contact Person’s Name: ____________________________________________           

Address:   _____________________________________________________________________

Phone: (Business and Cell)____________________________________________

Email: ____________________________________________________________

Date(s) and times for Using the Preserve: ____________________________________________

Activities to be Performed:   _______________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Email application, along with a valid certificate of insurance naming the Brandwein Institute and the Brandwein-Morholt Irrevocable Trust as additional insured for the date(s) of use, or a signed and acknowledged hold-harmless agreement, with a copy of photo identification to wsbav@optonline.net. You may email a purchase order for the $100 deposit. You may also mail the application, insurance certificate or hold-harmless agreement, purchase order or check for the deposit to William D. Bavoso, Brandwein Institute, 390 Minisink Turnpike, Port Jervis, NY 12771.

Email wsbav@optonline.net with any questions.

(Use the link below to print a copy of this form.)