"Trampoline Court Application" - Arizona

Trampoline Court Application is a legal document that was released by the Arizona Department of Forestry and Fire Management - a government authority operating within Arizona.

Form Details:

  • Released on September 7, 2017;
  • The latest edition currently provided by the Arizona Department of Forestry and Fire Management;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Arizona Department of Forestry and Fire Management.

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Arizona Department of Forestry and Fire
FOR OFFICE USE ONLY
Management
Initials
Fee Received
$
Attention: Trampoline Court Section
1110 W. Washington Street, Suite 100 Phoenix, AZ 85007
Date Received
Receipt #
Phone: (602) 364-1086 Fax: (602) 771-1421
Website: www.dffm.az.gov
Notes:
TRAMPOLINE COURT APPLICATION
About this form:
How to complete this form:
Use this form to complete the filing requirements under
Please print legibly or computer generate for accuracy.
Arizona Revised Statute: Title 37, Ch. 9, Art. 37-1423
For your convenience this form is available to be filled in
Please complete the form in its entirety. Use N/A if a field is
electronically on our website and printed to your printer.
not applicable.
Return completed form by mail or in person to the address
This form, and all attachments will be uploaded to our
above along with the appropriate filing fee.
website for public record pursuant to A.R.S. § 37-
1422(A)(5).
Fees: Please see the fee schedule on our Web site or the instructions section of this application
1. Trampoline Court Information
Trampoline Court Name:
Address (This is where the certificate is mailed)
City
State
Zip
Phone Number
Email Address
2. The following information must be included with this application in order to complete the filing pursuant
to A.R.S. §§ 37-1423(A)(2), 37-1423(A)(3) and 37-1423(A)(4)
Proof of Insurance or Insurance Certificate
Annual certificate of inspection by either; (1) the insurance company or (2) an inspector with whom the insurer has contracted.
Copy of the owner or operator’s business license.
3. Service Calls to Emergency Responders (Must be provided pursuant to A.R.S. § 37-1424(A)(6)
Date
Emergency Service Requested
Date
Emergency Service Requested
4. Authorized Signature
The undersigned swears to the best of his/her knowledge that the information contained on this application is true, accurate and complete.
Printed name:
Title:
Signature
Date
Notarization not required
Arizona Department of Forestry and Fire
FOR OFFICE USE ONLY
Management
Initials
Fee Received
$
Attention: Trampoline Court Section
1110 W. Washington Street, Suite 100 Phoenix, AZ 85007
Date Received
Receipt #
Phone: (602) 364-1086 Fax: (602) 771-1421
Website: www.dffm.az.gov
Notes:
TRAMPOLINE COURT APPLICATION
About this form:
How to complete this form:
Use this form to complete the filing requirements under
Please print legibly or computer generate for accuracy.
Arizona Revised Statute: Title 37, Ch. 9, Art. 37-1423
For your convenience this form is available to be filled in
Please complete the form in its entirety. Use N/A if a field is
electronically on our website and printed to your printer.
not applicable.
Return completed form by mail or in person to the address
This form, and all attachments will be uploaded to our
above along with the appropriate filing fee.
website for public record pursuant to A.R.S. § 37-
1422(A)(5).
Fees: Please see the fee schedule on our Web site or the instructions section of this application
1. Trampoline Court Information
Trampoline Court Name:
Address (This is where the certificate is mailed)
City
State
Zip
Phone Number
Email Address
2. The following information must be included with this application in order to complete the filing pursuant
to A.R.S. §§ 37-1423(A)(2), 37-1423(A)(3) and 37-1423(A)(4)
Proof of Insurance or Insurance Certificate
Annual certificate of inspection by either; (1) the insurance company or (2) an inspector with whom the insurer has contracted.
Copy of the owner or operator’s business license.
3. Service Calls to Emergency Responders (Must be provided pursuant to A.R.S. § 37-1424(A)(6)
Date
Emergency Service Requested
Date
Emergency Service Requested
4. Authorized Signature
The undersigned swears to the best of his/her knowledge that the information contained on this application is true, accurate and complete.
Printed name:
Title:
Signature
Date
Notarization not required
Arizona Department of Forestry and Fire
Management
Attention: Trampoline Court Section
1110 W. Washington Street, Suite 100 Phoenix, AZ 85007
Phone: (602) 364-1086 Fax: (602) 771-1421
Website: www.dffm.az.gov
INSTRUCTIONS
1. Procure insurance policy for the Trampoline Court.
a. Pursuant to A.R.S. § 37-1424(A)(3) the insurance policy must:
i. Be issued by an insurer authorized to do business in this state pursuant to section 20-217 or
by an insurer on the list of qualified unauthorized insurers pursuant to section 20-413
ii. Insure the owner/operator against liability for injury to persons arising from the use of the
trampoline court.
iii. Be in an amount of not less than one million dollars for bodily injury.
b. Insurance Company will send an authorized inspector to perform an inspection of the trampoline court to
ensure the American Standard for Testing and Materials Standards (“ASTMS”) are substantially met. This
inspection must occur at least once annually, pursuant to A.R.S. § 37-1424(A)(1).
i. Authorized Inspector will either:
1. Provide the owner/operator of the Trampoline Court with a “Certificate of Inspection”
indicating the inspection was passed.
2. Notify the Department and the Owner/Operator of the component that does not meet the
ASTM Standard and will not provide the “Certificate of Inspection” until the ASTM standards
are substantially met.
c. Certificate of Passing Inspection from Authorized Inspector will be issued to the Trampoline Court and must
be provided to the Insurance Company.
d. Insurance Company issues Certificate of Insurance for at least $1 million dollar liability after the Trampoline
Court has been approved by the Authorized Inspector as compliant with the ASTM standards.
2. Complete the Application in its entirety. Do not leave blanks, if a section is not applicable, please put “N/A”.
3. Compile all of the following required documentation:
a. Proof of Insurance Policy outlined in section 1 (above) providing coverage for the next year.
b. Annual certificate of inspection issued by the insurance company, or an inspector with whom the insurer has
contracted.
c. Copy of the owner/operators business license.
4. Pay the Fee:
a. Cashier’s check or money order please - payable to the “Department of Forestry and Fire Management”.
i. Initial registration= $250
ii. Renewal registration fee = $100
5. Submit the Application:
a. Include copies of required documentation listed in number 3-above.
b. Include the applicable filing fee outlined in number 4-above.
After Submission of the Application:
6. Certificate of Registration will be mailed to the trampoline court and must be displayed in the facility.
7. Track all calls to emergency responders. Maintain those records of emergency calls for 2 years.
8. Repeat the application process annually. Applications for renewal will be accepted 90 days before expiration.
9. Notify the Department of any changes to any information on the application throughout the year.
a. Complete trampoline court application and include cover letter explaining it is notification of a change, and
not a renewal. No Fee will be charged.
TCA09072017
Trampoline Court Registration Application Form
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