Camper Information & Contract
LICENSE OF OCCUPATION BETWEEN CEDAR GROVE TRAILER PARK OWNER AND
Occupant Full Name: _______________________________________________________
Permanent Home Address: ___________________________________________________
City/Town: ________________Province: _____________Postal Code: _______________
Email: ______________________________
Telephone Number – residence: _______________________ work: __________________
Trailer Make:_____________________ cell: ___________________
Is address on license the same as permanent home address Yes _____ No _____
Car License Plate #: _____________________________ Make: _________________
ATV Make: ___________________________________ Boat Make: _____________
Proof of Insurance on trailer: _______________________________________________________
Emergency Contact: _____________________________Relationship:______________________
Telephone Number: _________________________
The Owner has agreed to license the Occupant to occupy the following site address
Lot #___________________________________________ with the services specified.
This license is personal to the above-named Occupant and those eligible family members listed below:
Partner: _____________________________
List unmarried dependent children 18 years and under, living at permanent home address:
Name: ______________________________ Date of Birth: _________________________
Name: ______________________________ Date of Birth: __________________________
Name: ______________________________ Date of Birth: _________________________
This Agreement signed the __________(day) of _________(Month), ______(Year), at Whitefish, Ontario shall be binding upon the heirs, executors, administrators and assigns of the parties hereto.
Signed and Delivered in the presence of
________________________ ________________ ___ X_______________________
Name of Witness (Print) Name of Owner Name of Occupant (Print)
_______________________ ____________________ X___________________
Signature of Witness Signature of Owner Signature of Occupant
I, the named Occupant for the specified site, acknowledge providing the personal information pursuant to this contract and confirm the accuracy of the same. I, the named Occupant, consent to the disclosure of this personal information for the use of the owner as required from time to time to administer and enforce the agreement between the parties to this contract.
X_________________________________ X_____________________________________
Date Signature of Occupant
ID INSURANCE
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