2022 Golf Cart Registration Form

Hidden Valley Lake Property Owners Association 19303 Schmarr Drive, Lawrenceburg, IN 47025 * (812)537-3091 Fax: (812)537-1521

Golf Cart Registration Form

Lot #

Name

Mailing address

Home Phone

Work/Cell

Make

Model

Color

Tag Number: (To be entered by staff)

Tag Number

Insurance Company

Insurance Effective Dates

Date

Insurance Provider Contact Name

Insurance Provider Contact Phone Number

I acknowledge that my use of Hidden Valley Lake streets, roadways and/or parking areas for my golf cart is at my risk.

First Name Last Name

Note: You must have your insurance declarations page with you when registering your vehicle. It must include names of insurance company, insured, coverage dates, and a minimum of $100,000 liability coverage. Golf Cart Release of Liability Agreement

and/or parking areas for my golf cart is at my risk. Iagree that I will follow the HVL Community rules, outlined in Section 10-11-3 of our Hidden Valley Lake Property Owners Association Bylaws concerning motorized vehicles. Furthermore, I understand that Hidden Valley Lake Property Owners Association bears no liability for accidents or incidents associated with my golf cart. I agree to: Register my cart with the HVL POA office by April 30th each year. Provide proof of State registration if vehicle is other than a standard golf cart. Pay the $50.00 annual registration fee. Show proof of insurance for my cart at the time of registration. Display the registration sticker on the left rear bumper of the cart. I have read this Release of Liability Agreement. I fully understand its terms and signit voluntarily and without inducement. I understand that any cost to Hidden Valley Lake Property Owners Association, related to incidents involving my cart, will be added to my account and will be paid by me

Signature

Clear

Date

FOR OFFICE USE ONLY

Member on Deed? /Dues Balance S

Member on Deed? /Dues Balance

cash/cc/ck #

Received by

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