Middle Tennessee State University - Campus Recreation
Climbing Wall Reservation Application
The Indoor Climbing Wall is available for scheduled group use outside of the regularly scheduled
hours. A reservation and full payment are required for group use.
This Climbing Wall Reservation Application is to be completed and submitted to the main
Campus Recreation office along with a $25 deposit at least two weeks prior to requested date.
Group climbing sessions are 1 ½ to 3 hours in length.
Cancellations made at least 48 hours in advance of the scheduled event will result in a refund
minus a $25 processing fee. Cancellations made less than 48 hours in advance of the
scheduled event will result in a forfeiture of the full payment.
Campus Recreation must receive a Waiver of Liability and Hold Harmless Agreement signed
by each participant and/or parent/guardian.
Department / Organization (if applicable) ________________________________________________
Name / Representative _______________________________
Today’s Date _____/_____/_____
Address ______________________________ City/State ___________________ Zip__________
Cell Phone ___________ Work Phone ____________ Home Phone ____________ Fax __________
Email __________________________________________________________________________
Date(s) Requested _________________________ Time (from-to) ________________________
Age Group of Participants (min age is 5 years old)________________
Size of Group: (Please list actual number attending) _________ Up to 10 participants $50
_________ Groups larger than 10 it is $50 for the first 10,
then $6 per person thereafter
Return to: MTSU Campus Recreation, P.O. Box 556, Murfreesboro, TN 37132
Phone: (615) 898-2104
FAX: (615) 898-5568
Web Site: www.mtsu.edu/~camprec
__________________________________________________________________________________________
OFFICE USE ONLY:
___ Approved ____/____/____
Amount of Rental $______________
___ **Not Approved ____/____/____
Receipt # of Payment _______________
___ Cancelled ____/____/____
Date of Receipt _____/_____/_____
___ Waiver sent ____/____/____
University Account # (if applicable) __________________
___ Verification Date ____/____/____
Reservation has been entered into reservation calendar Yes ( ) No ( )
____/____/____
Approved by _________________________________
(Climbing Wall Supervisor)
7/12/2010