Park Use Permit Application

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All community events, programs, competitions, festivals or other commercial or not-for-profit use of Cumberland Lake Park require prior authorization from Lake Park Society (LPS), annually. Please complete this application at least four (4) weeks before your event.

Permit Requirements

Submit a completed copy of this Park Use Permit Application and receive approval from LSP staff.

Pay associated permit fees, as assessed by LPS staff per the LPS Park Use Fees

Submit proof of comprehensive general liability insurance that meets the requirements detailed in the Insurance Requirements Matrix tool. If insurance is required, it must name BOTH of the following as additionally insured on your policy: “Village of Cumberland”, 2673 Dunsmuir Ave PO Box 340, Cumberland BC, V0R 1S0, (250) 336-2291, AND “Cumberland Lake Park Society”, 1100 Comox Lake Road Po Box 1389, Cumberland BC, V0R 1S0, (250) 702-8833

Sign the Release of Liability, Waiver of Claims, Assumption of Risks and Indemnity Agreement

Comply with all other terms and conditions of the permit and submit any additional documentation, as required

Personal information provided in Park Use Permit applications and in communications with LPS is collected, used, stored, and disclosed in accordance with BC’s Freedom of Information and Protection of Privacy Act (FOIPPA), may be subject to access requests, and is protected by security, storage, and disclosure rules that limit use to authorized purposes only.

Applicant Information

This person will attend the event and/or be the primary contact person regarding this permit

Applicant First & Last Name *

Applicant Email *

Applicant Phone Number *

Organization Name

Organization Email, if different

Organization Phone, if different

Street Address *

City

Province / State *

Country *

Postal Code / Zip *

On-Site Contact

Not Applicable – the applicant will be present

On-Site First and Last Name

On-Site Phone Number

On-Site Phone Email

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