Land Use Form Program Information Program Name * Is this a recurring program? Share additional dates and details here. Program Contact * Phone * Email * Alternative Contact Phone Email Check-out Contact * When you finish your program at the time specified below, the check-out contact must stop by the gateway building and do a brief land walk with a Topa staff member to ensure there is no damage, lost property, etc. Phone * Arrival Date * Time * 121234567891011 : 0030 AMPM Departure Date * Time * 121234567891011 : 0030 AMPM “Departure Time” is when all guests and group leaders will have departed the ridge. Be sure to leave enough time between your scheduled program end time and your group’s departure time to allow for packing up, checking out, informal conversations, independent land walks, etc. An additional $75 per hour fee applies to land use outside the hours listed in your venue rental contract. Check this box to show you understand and agree to the after hours policy. * I understand and agree to the after hours policy Daytime Group Size * Overnight Group Size * Additional Program or Group Notes Teaching Tree Setup Needs Backjacks Specify how many and your preferred layout (circle, horseshoe, rows, etc) Woven Plastic Chairs Specify how many and your preferred layout (circle, horseshoe, rows, etc) Carpets Yes, I need carpets No, the ground is fine Council House Setup Needs Backjacks Specify how many and your preferred layout (circle, horseshoe, rows, etc) Wooden Folding Chairs Specify how many and your preferred layout (circle, horseshoe, rows, etc) Zabutons Large square meditation cushions. Zafus Small round meditation cushions. I need the carpets rolled up and placed against the wall Yes Meals Meals will be served * Yes No Packed Lunch Restaurant Delivery Food Truck Caterer (please share their contact info)Caterer (please share their contact info) I need tablecloths Planned Mealtimes Dining Area Layout One long table, multiple small tables, picnic benches, shade canopy (subject to availability) etc. Other spaces The ridge has many outdoor gathering areas, let us know if you have any needs or requests. Additional Services My group would like a guided land walk * Yes No Subject to availability. Date Time 121234567891011 : 0030 AMPM My group would like tea and coffee * Yes No Tea and coffee can be set up in the Council House entryway for $20 per day for groups under 20 and $40 per day for groups between 20 and 50. Contact us about tea and coffee for groups over 50. Group is strongly encouraged to bring their own closed beverage containers to cut down on waste and because only beverages with lids may be taken into the Council House. My group would like to use a fire kiva * Yes No Please check off which kiva(s) you intend to use and provide your planned usage date(s) and time(s) Firewood is available for $60 per wheelbarrow, or groups may elect to bring their own. * Hearth Kiva (by the dining area) Camp Kiva (by the oak grove) Deep Kiva (across from the Council House) Please note that the Deep Kiva is $150 per use. All other kivas are available to use for no cost (aside from firewood) I agree to the following terms and conditions for kiva usage during my program at Topa Institute * Someone must attend to the fire at all times when burning Option Fire tender must know where the closest hose is. Water should only be used to extinguish fire in the case of an emergency Fire must be completely extinguished by allowing kindling to burn out fully. Note: this may take some time, so plan accordingly Any remaining hot ashes must be shoveled into the metal buckets located in the kiva and the lid firmly closed on the metal bucket in order to extinguish any remaining embers or flames In order to prevent reignition, the fire area must be cool to the touch after burning out Please check each box. Kiva Usage Date * Start Time * 121234567891011 : 0030 AMPM End Time 121234567891011 : 0030 AMPM If you are using more than one kiva or if you are using kivas on multiple dates, or if you have any other notes, please share: Other setup requests Credit Card Information Held on file in case of damage (besides normal wear and tear), destroyed, or lost as a result of your group’s actions. Card Details * Card Details Card Details Card Details Month 123456789101112 Card Details Year 20262027202820292030203120322033203420352036 Card Details Billing Address * Billing Address Street Address Line 1 Street Address Line 1 Street Address Line 2 (optional) Street Address Line 2 (optional) City City State State Zip Code Zip Code Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Office Use Only Cleaning required before program Have cleaners been notified and confirmed? Cleaning required after program Have cleaners been notified and confirmed? Group glamping tent 1 required Group glamping tent 2 required Twin glamping tent 1 required Twin glamping tent 2 required Exclusive land use Liability waivers Has group been sent a copy, reminded that they need to collect these, is a Topa person responsible for reminding the group leader or collecting them on group’s behalf? Caretakers needed Have they been notified and confirmed? Check-in point of contact Have they been notified and confirmed? Check-out point of contact Have they been notified and confirmed? Extreme weather plans Relocation plan if too hot, canopies if raining? Calculate extra fees Tea/coffee, Deep Kiva, firewood, change in group numbers since contracting. Additional Notes Submit If you are human, leave this field blank.
