Dock Registration | Moosic Lakes

2026 COMMON AREA DOCK REGISTRATION FORM

Dock Owner/Designated Representative

Dock Location

Dock Composition

e.g., wood, metal, composite, etc

Year Dock Was Originally Built

Square Footage of Dock

Method of Dock Anchoring

e.g. floating, moored, fixed, pilings

Condition of Dock

1-10, with 1 meaning needs repair and 10 meaning like new

Acknowledgements (Initial After Each)

I have read, and understand and acknowledge the Rules and Regulations of the Moosic Lakes Club (“MLC Rules”)

I acknowledge that permission to place docks at Common Areas is at the discretion of the Board of Directors, which may be withheld or withdrawn for any reason

I agree that docks placed on Common Areas (as defined in the MLC Rules): Do not affect ownership rights of the Common Areas

Are permitted at the sole discretion of the Board of Directors

Are required to be maintained for safety by the Dock Owner/Designated Representative named above, and will report any potential safety hazards to the Board

May be used by all Moosic Lakes Clubs Members without preference or rights of first

I agree that the dock subject to this registration form will be removed or pulled towards the shore before the first freeze

I acknowledge that this registration and the fee paid herewith is applicable only for the calendar year stated above, and a new form and fee is required annually

I acknowledge that the Board will attempt to obtain insurance for the dock through its insurance based on the information provided herein, and that should the insurer refuse coverage for whatever reason, the Board may withdrawal approval of the dock.

The Board of Directors will endeavor to provide information as to why coverage is denied, such that the Dock Owner/Designated Representative may attempt to remedy any found issues or the Dock Owner/Designated Representative may obtain its own insurance and provide proof of the same to the Board of Directors

Please attach photographs of the dock’s current state sufficient to show: size, placement, condition, and composition.

First name

Last name

Address

Phone

Registration fee

$10