Cossio Insurance Agency Family Entertainment Centers
Activity 3
NOTE: Remember not to hit your back button or your refresh button so that you do not
accidentally erase or wipe out any type of information that you have typed in.
Please click on an operation type from the list. Then answer the questions inside each operations. After
completely answering the questions, you may click on a new type of operation to begin completing new sets of questions.
Ice Skating
Type:
(Please click on all that apply)
Gen. Admission
Open Public
Skate Rental
Hockey
Rink Rental
Ticket Sales to Spectators
Rink Sponsored Lessons
Gen. admission annual sales:
$
Open public annual sales:
$
Skate rental annual sales:
$
Hockey annual sales:
$
Rink rental annual sales:
$
Ticket sales to spectators annual sales:
$
Rink sponsored lessons annual sales:
$
No. of years in ice rink business:
Do you have seating for spectators:
Any patrons given waivers to sign?
Yes
No
Max. no. of skater per floor guard:
Max. capacity of rink:
Date floors/skating surfaces were resurfaced:
Do you have netting?
Yes
No
Do you have competitions?
Yes
No
Are there sponsoring or sanctioning organizations?
Yes
No
Please provide names of organizations:
Are rink rules posted?
Yes
No
If yes, please click on the browse button to upload the rink rules.
Written emergency plan?
Yes
No
Video Surveillance?
Yes
No
Please describe video surveillance:
List skating associations of which you are a member:
As respects rink rental, do you collect certificates of insurance?
Yes
No
Do participants sign individual waivers?
Yes
No
Is there a scheduled maintenance plan?
Yes
No
Location address:
City:
State:
Zip code:
Construction:
Fire Resistive
Masonry Non-Comb.
Joisted Masonry
Frame
Other
If other, please describe:
Facility Sprinklered?
Yes
No
Burglar alarm?
Yes
No
Type?
Cen. Station
Local
Please click on the browse button to upload the waiver.
Please click on the browse button to upload the rental agreement.
Sq. ft. area of surface:
Surface composition under ice:
Rink Type:
Indoor
Outdoor
Waivers/disclaimers on ticket?
Yes
No
Inflatables
Annual sales:
$
How many different types of inflatable devices do you currently own:
Name:
Manufacturer:
Receipts:
Describe
Attraction ht:
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Miniature Golf
Annual sales:
$
No. of courses:
No. of holes:
Waterfall or fountains w/ ground fault interrupters?
Yes
No
Miscellaneous Activities
Types of Miscellaneous Activities:
(Please click on all that apply)
Euro Bungee
Trampolines
Rope ladders
Mechanical bull
Shuffleboard
Simulators
Volleyball/Basketball
Tennis courts
Billiard/Pool table
Euro Bungee:
Annual sales:
$
No. of attendants:
Trampolines:
Annual sales:
$
No. of attendants:
Rope Ladders:
Annual sales:
$
No. of attendants:
Mechanical bull:
Annual sales:
$
No. of attendants:
Shuffleboard:
Annual sales:
$
No. of attendants:
Simulators:
Annual sales:
$
No. of attendants:
Volleyball/Basketball
Annual sales:
$
No. of attendants:
Tennis Courts:
Annual sales:
$
No. of attendants:
Billiard/Pool Table:
Annual sales:
$
No. of attendants:
Please make sure that you have completed everything to the best of your knowledge before going to the next page.