Terms and Conditions

The Booking Conditions
1.1 The contract entered is between us (the Owner) and the person completing and signing the Booking Form (the Hirer). The contract is for the provision by the Owner of short-term holiday rental accommodation, (the Holiday Home) for the dates of your booking (the Stay), in accordance with the following booking conditions. These Booking Conditions shall apply to and form part of the Contract and the Contract shall be governed by English Law. These terms and conditions do not affect your statutory rights.
1.2 The Hirer must sign both the Booking Form and these Booking Conditions. The signature confirms agreement to the Booking Terms and Conditions by all those persons named on the Booking Form. All of the persons named on the Booking Form shall constitute the Hirer.
1.3 The contract is not effective until the Owner has received the Deposit payment, signed Booking Conditions and has confirmed the booking either by post or by email to the Hirer.
1.4 The Owner reserves the right to decline any booking or to refuse to hand over a key to any person who has not complied with the Booking Conditions.

2. Booking
2.1. A Booking is the confirmed reservation of the Property to commence on the Arrival Date, (the date and time on which your Booking will begin) when the Property will be made available to you and will end on the Departure Date (the date and time on which your Booking will end and when you must vacate the Property).
2.2. Bookings cannot be accepted from:
2.1 . Persons under 25 years of age; and or
2.3 . Parties where the majority of members are younger than 25 years (except families or supervised groups).
2.4 At the time of booking or when otherwise requested by us, the Hirer must provide a list of the names, postcodes, contact details and approximate ages of all adults, children and infants that will be staying in the Holiday Home . The Hirer is entitled to change members of the booking party prior to arrival provided that they do not exceed the maximum occupancy of the cottage, (or the reduced occupancy agreed at the time of booking if lower); however where you have previously provided details of the booking party to us, we will need you to provide details of any such changes. The Hirer is responsible for ensuring that all members of the booking party comply with the Terms of Use (as set out below), however, the Contract for the provision of the Holiday Home is between the Owner and the Hirer (as the person making the booking).

3. Payment
3.1. Bookings are not Confirmed until receipt of all of the following:
3.1.1. twenty five per cent (25%) of the cost of the stay (the Deposit), or full payment if you are booking within Eight (8) weeks of the Stay when full payment is then required;
3.1.2. the completed Booking Form; and
3.1.3 these the signed Booking Conditions
3.2 The Deposit forms part of the payment for your Stay and will only be refundable in the circumstances set out in Clause (4) below.
3.3 Full payment is due at the time of booking if your booking is made within Eight (8) weeks of the start of your Stay.
3.4 The balance of the rental sums will be due for payment Sixty Days prior to the date of the Stay. We will send you a payment reminder.
3.5 We are entitled to cancel a Stay where payment has not been received when due. We will send you two reminders before any such cancellation. If we cancel in such circumstances, we will attempt to re-let the Holiday Home. If we are able to re-let the Holiday Home you may be entitled to a refund or your liability to us may be reduced (in the same way as envisaged by Clause 4.2).
3.6 Once you have a confirmed booking, your ability to cancel and receive a return of any monies paid by you is set out in Clause (4) below.
3.7 Once a booking is confirmed the dates of your Stay are not transferable other than by us in the limited circumstances contemplated by Clause (4.7) below following a Force Majeure Event. If you are unable to make use of your booking, you may transfer your booking to a third party with our consent which we will not withhold unreasonably.
3.8 It is your responsibility to ensure that you have adequate travel insurance in place to cover any loss or damage that you may suffer as a result of any cancellation of your Stay. We strongly recommend that you consider taking out such insurance immediately following your booking being confirmed. If you choose not to take out UK travel insurance, then you accept responsibility for any loss that you may incur due to your cancellation.
3.9 The Hirer agrees to provide a copy of their travel insurance documentation that relates to their Stay at the Holiday Home upon request of the Owner.

4. Cancellation
4.1 If you need or wish to cancel the booking, you need to confirm your intention to cancel in writing to the Owner as soon as possible. It is important that you notify the Owner as soon as possible should you wish to cancel, as this will give us a chance to re-let the Holiday Home.
4.2 The Owner will apply a cancellation charge in accordance with the scale shown in the table below to bookings to determine the amount of the charge, which shall be a percentage of the total cost of the holiday that is to be due in the event of cancellation of the Stay by the Hirer:

4.3 On receipt of the cancellation, the above Chart states the amount that the Hirer remains liable for at that point in time. The Owner will then use reasonable endeavours to obtain a replacement booking. In the event that the Owner is successful in obtaining a replacement booking, the Owner will refund to the Hirer the total amount paid by the Hirer for the booking less the 10% Booking Fee and less the difference in price between the Hirers’ booking and the replacement booking if one is made.
For example:  A £1000 booking, fully paid, cancelled and relet for £900, means that the Hirer will be refunded as follows, £1000, less the 10% booking fee equals £900, less £100 rebooking shortfall, equates to a Refund of £800.

4.4 It is the responsibility of the Hirer to acquire suitable travel insurance for themselves and their party to cover the booking. The Owner strongly recommends that the Hirer acquires suitable insurance to cover circumstances beyond the Hirers’ control such as, but not limited to, jury duty, incarceration, change in personal or work circumstances, military service, illness, including Covid-19 and shielding, family emergencies and travel delays. Covid is also now a known risk and it is possible for you to insure your holiday against it. This can include the customer or any of the party having Covid, the customer or any of the party having to isolate or quarantine, or you wishing to shield any Members of the party.

4.5 The inability of the Hirer (or the inability of any, some or all of the intended occupants) to travel to and stay at the Holiday Home for any reason (including but not limited to, illness, requirement or recommendation to self-isolate or quarantine, jury duty, incarceration, change in personal or work circumstances, family emergencies and travel delays) remains at the Hirer’s risk and does not give rise to a right to cancel or to receive a refund other than under the terms of this Clause 4.

4.6 Cancellation by the Owner
If the Owner’s performance is hindered or prevented by a Force Majeure Event (please see definition below), the Owner may, at the Owner’s sole discretion, offer the Hirer:
(a) a full or partial refund; or
(b) alternative dates; or
(c) such other remedy as the Owner considers appropriate (acting reasonably) with regard to the circumstances.
The Owner will not be liable to pay any amount in excess of the total amount paid for the Stay.
For the purposes of this Contract, Force Majeure Event means any of the following circumstances which may hinder or prevent the performance by us of the Contract, including but not limited to: (a) acts of God, flood, drought, earthquake or other natural disaster; (b) epidemic or pandemic; (c) terrorist attack, civil war, civil commotion or riots, war, threat of or preparation for war, armed conflict, imposition of sanctions, embargo, or breaking off of diplomatic relations; (d) nuclear, chemical or biological contamination or sonic boom; (e) any law or any action taken by a government or public authority, including without limitation imposing a restriction, prohibition, or failing to grant a necessary licence or consent; (f) collapse of buildings, fire, explosion or accident; (g) any labour or trade dispute, strikes, industrial action or lockouts; (h) non-performance by suppliers or contractors; and (i) interruption or failure of utility service.
4.7 The Owner reserves the right to refuse to hand over the Holiday Home to (or to allow the continued occupation by) any person who in the Owner’s reasonable opinion is not in a suitable state to take charge of it.
4.8 The Owner reserves the right to require any guest to leave the Holiday Home and the site where, in the Owner’s reasonable opinion, the guest fails to observe the Terms of Use or otherwise poses a threat to the Owner’s safety or the safety or enjoyment of other guests or causes damage to property or danger to others.
4.9 In the circumstances described in 4.7 and 4.8 no refunds shall be given unless the Owner is able to re-let the Holiday Home and having done so have fully recovered any costs associated with the relevant circumstances.
4.10 The Hirer’s inability (or the inability of any, some or all of the Hirer’s intended party) or disinclination to travel to and stay at the Holiday Home for any reason, includes but is not limited to illness (including Covid-19), a requirement or recommendation to self-isolate or quarantine, shielding, a call to jury duty, military service, incarceration, change in personal or work circumstances, family emergencies, travel delays, vehicle breakdown, and delays with public transport.  These remain at the Hirer’s risk and do not give rise to a right to cancel or to receive a refund unless the Owner is able to re-let the Holiday Home. The Hirer is strongly recommended to take out UK travel insurance to cover these eventualities. If you choose not to take out UK travel insurance, then you accept responsibility for any loss that you may incur due to your cancellation.
4.11 Cancellations must be notified to the Owner by email and once received in writing the Owner will confirm the cancellation request.
4.12 In order to ensure speedy receipt, and thereby processing, of cancellations, the Owner recommends that the Hirer sends written notification of cancellation by email requesting confirmed receipt. The effective date of cancellation is when written notification is received by the Owner. Any amounts due for refunding will be made within 14 Days. 

5. Period of Hire (Arrival and Departure)
5.1 The Hirer and any member of the Hirer’s guests should not arrive before 4:30pm on the commencement date of the Stay. The Owner cannot accommodate early arrival or late departures as the Owner needs this time to perform maintenance and cleaning to the Holiday Home and the site as a whole.
5.2 The Hirer and all members of their group MUST leave by 10am on the day of departure. Housekeepers are booked to arrive on site at 10am. Should the Hirer delay access to housekeeping because of late departure, a late departure fee of £30 will be levied for the first 30 minutes and every 30 minutes thereafter.

6. Holiday Home Use
6.1 The Hirer must not use the Holiday Home except for the purpose of a holiday during the holiday period, and not for any other purpose or longer period. The Contract to Stay in the Holiday Home for the holiday period, does not create the relationship of Landlord and Tenant between the parties. You shall not be entitled to a new tenancy, or to any Assured Shorthold or Assured Tenancy or any Statutory Protection under the Housing Act 1988 or other statutory security of tenure now or at the end of the Holiday Period.
6.2. All male or all female parties of five or more will not be allowed without the prior written agreement of the Owner.
6.3. The Owner will provide fresh and clean bed linen, bath, and hand and kitchen towels for use in the Holiday Home only. They must not be removed from The Holiday Home.
6.4. A travel cot and high chair are available at no extra cost on request.
6.5. All electricity, gas and water costs are included in the rental price.
6.6. Although the Owner takes care to ensure that the particulars on the Beachpad’s website are correct, the Owner is not liable for any changes that may occur between the present and the time of the Guest’s arrival and stay at the Holiday Home.
6.7 Due to the unique nature of the properties they are not deemed suitable for disabled access.
6.8 It is essential that you confirm your bed configuration requirements prior to arrival. Failure to do this will result in a housekeeping call out charge and linen fee. Housekeeping operatives are not based on site.

7. Third Party Suppliers (chefs etc)
7.1 If the Hirer wants to use the services of a third-party supplier whilst staying at the Holiday Home they must ask and receive written permission to do so. This may be for a chef, beauty treatments, bouncy castle hire, magicians, opera singers, swimming teachers, baby-sitters , etc.
7.2 The Owner would need to see the third-party supplier’s public liability insurance, and any other related/required certification. The Owner will then seek approval from the Owner’s insurers to allow the third-party activity to take place.
7.3 If all insurances and certification are satisfactory to the Owner and their insurers, permission to invite these suppliers to the Holiday Home will not be unreasonably withheld.
7.4 The Owner does not accept any liability for the activities of these third-party suppliers.

8. Number of Persons using the Holiday Home
8.1 Under no circumstances may more than the maximum number of persons stated on the web site occupy the property. The Owner reserves the right to refuse admittance if this condition is not observed. Any persons other than members of the Hirer’s group listed on the Booking Form must not use the facilities at the Holiday Home. Should any third party use the Holiday Home without the prior written consent of the Owner then the security deposit shall not be returned.

8.2 Your booking will provide for a maximum number of persons (including children and infants) who may occupy the Holiday Home. This will either be agreed with you at the time of booking, or otherwise will be the capacity of the Holiday Home as stated on the website. In exceptional circumstances, the Owner may be able to accommodate an additional bed, (a z-bed provided by the Owner) in certain rooms, however this will be subject to overall limits on guest numbers across the site and may be subject to a supplemental fee.  The identity of anyone staying at the Holiday Home must be disclosed to the Owner prior to their arrival, (if they are not mentioned on the booking form).  We reserve the right to refuse admittance or require the Hirer or the additional persons to leave if this condition is not observed.

8.3 If the Hirer wishes to invite additional visitors to visit them in the Holiday Home during your Stay, please ask us.  The Owner will try to accommodate this but we need to comply with the maximum site occupancy limits and consider other guests.  Such visitors will not be permitted to use any of the site facilities which are for booked guests only.

8.4 You must not use the Holiday Home or the site for any illegal, dangerous, offensive, noxious or noisy activities or behave in a way that may be a nuisance or annoyance to us, other guests or neighbours. Porthkidney Beach is a very peaceful location and we ask that you respect that and other guests.  As such, the playing of music, singing or other excessive noise that can be heard outside of your Holiday Home after 10pm is not permitted.
8.5 Smoking is not allowed in any of the cottages or any other buildings on the site. Smoking on the grounds should be away from the buildings and will be tolerated provided that all cigarette ends are disposed of properly.  Vaping is permitted outside.

8.6 The Hirer’s use of the Holiday Home does not entitle you to charge an electric vehicle or appliance other than personal electronic devices.  If the Hirer has particular charging requirements, please get in touch before the Stay to discuss this.

9 Supervision
9.1 There must be at least one capable and responsible adult over the age of 21 in the Holiday Home.
9.2 The Hirer is responsible for the physical supervision of all members or the party under the age of 18 at all times. This is particularly important in all children’s play areas, close to the sea and river or if using any amenities such as a swimming pool or hot tub.
9.3 Parties not supervising their children responsibly may be asked to put appropriate arrangements in place or to leave the relevant facility.

10. Care of the Holiday Home
11.1 The Hirer is responsible for the Holiday Home and is expected to take all reasonable care of its furniture, pictures, fittings and effects, in or on the property. All fixture and fittings remain the property of the Owner and must not be taken away from the property. The Hirer MUST leave them in the same state of repair, and in a reasonable clean and tidy condition at the end of the Stay. The Hirer must not use the properties for any dangerous, offensive, noxious, noisy, illegal or immoral activities or carry on there any act that may be a nuisance or annoyance to the owner or other neighbouring properties. Smoking is not allowed in the Holiday Home. Any damages will have to be paid for in full within seven days of notification. The Owner recommends that the Hirer has travel insurance in place to cover this.
11.2 If damage occurs to the Property as a result of the actions of the Hirer during the stay, where the extent of that damage is so severe that the Owner must (in their sole opinion) cancel and/or refund subsequent bookings, the Owner may bring a claim against you for any loss arising as a result, including the cost of refunding other guests affected by cancelled Bookings and any additional administrative fees incurred in respect of the same

11. Cleaning
11.1 On departure, please leave the Holiday Home as you found it, in a clean and tidy condition. Please ensure that you have washed and dried up (or loaded the dishwasher and started the cycle), and ensure that ovens and barbecues are clean and free from grease. Please return any furniture or other items that you have moved back to where they were at arrival.

13. Liability
13.1 The Owner, their employees and representatives shall not be liable to the Hirer or the Hirer’s Group for loss or damage to property howsoever arising. You must take all necessary steps to safeguard yourselves and your property.
13.2 The Owner, it’s employees, contractors and representatives shall not be liable to the Hirer or Hirer’s party for accidents or injuries to you and your party, either within the property or outside unless demonstrably caused by the Owner’s negligence or wilful misconduct or that of those for whom we are legally responsible.
13.3 The Owner shall not be liable to you for the failure or non-availability of any particular facility in the Holiday Home or at the site although in all cases we will seek to rectify any such failure as soon as is reasonably practicable.

14. Damages, Breakages and Security Deposit
14.1 The Hirer is legally bound to reimburse the Owner for replacement, repair or extra cleaning costs on demand.
14.2 Prior to the Stay the Hirer will be asked to pay a security deposit of Five Hundred Pounds (£500) for Beach House, One Thousand Pounds  (£1000) each for Ferry House or Ferryman’s Rest. The Owner will ask that the Hirer look after the Holiday Home and its contents as if it were your own home and hand it back to us in the same condition as it was at the start of the Stay. If the Hirer or any of the guests mistreat the Holiday Home or its contents (or fail to comply with other obligations giving rise to costs incurred by the Owner), the Hirer is required to cover the cost of any resulting damage and this will be deducted from your security deposit. The security deposit is principally to cover repairs or replacements as a result of damage and breakages and/or extra cleaning costs — for example where the Holiday Home has not been returned to us in accordance with the departure cleaning requirements. If the Hirer loses a key it will be replaced and deduct this cost from your security deposit.
14.3 The Owner appreciates that accidents can happen and therefore takes a pragmatic and sensible approach to damage and breakages. The Owner would not charge you for the odd broken mug or glass, but please do inform the Owner of any breakages or damage so that we can put it right. However, for example if you decide to dye your hair and the product used discolours tiles / fittings; if you apply tanning products and this spills on and discolours the furnishings; or if you leave pots and pans unwashed or with burnt on food residue then we will need to deduct the cost of putting things right.
14.4 The security deposit will be refunded to the same place from where the payment was made, usually within ten (10) working days of your departure (subject to any deductions made).

15. WIFI
Wi-Fi is provided for the Hirer’s reasonable use. The Hirer agrees to reasonable and lawful usage of this service.

16. Right of Entry
The Owner shall be allowed the right of entry to the property at all reasonable times for purposes of inspection or to carry out any necessary repairs or maintenance.

17. Electric Vehicle Charging
17.1 Electric Vehicles (EV) are not permitted to be recharged at the Holiday Home, including any garden, grounds, outbuildings, garages or communal spaces.
17.2 This provision applies to all members of the Booking Party. It shall be the responsibility of the Hirer to inform all members of the Booking Party and any visitors to the Holiday Home.
17.3 For the purpose of this provision an EV is any vehicle that uses electric motors, either fully or partially, to drive its wheels. It will derive some or all its power from rechargeable batteries which requires connection to the electricity grid (plug-in). This includes fully chargeable and plug-in hybrid cars, motorbikes, buggies, scooters, mopeds, bicycles, utility vehicles and tracked vehicles.
Domestic charges are not permitted at the Property
17.4 Most EVs are supplied with a domestic charger, commonly known as a ‘granny charger’ or a ‘trickle charger’. These cables recharge the EV using a domestic power source via a 3-pin wall socket.
17.5 Domestic chargers are not suitable for use in the Holiday Home and will create a fire hazard. The use of domestic chargers is strictly forbidden.
17.8 We retain the right to carry out reasonable inspection, on a without notice basis, to ensure that granny chargers are not in use in the Property.
17.9 You are solely liable for any damage or loss suffered by us as a result of your unauthorised use of domestic chargers.

18. Problems, Concerns or Complaints
18.1 It is the Owner’s mission to ensure the Hirer has an enjoyable stay (The Owner knows how much they look forward to their holidays and are sure that the Hirer is no different). So if the Hirer has any problem or cause for complaint, the Owner asks that the Hirer contact the Owner as soon as possible to give the Owner the best chance to resolve it. The Owner cannot fix anything necessary for the enjoyment of your Stay if it is notified after your departure. There will therefore be no recourse for any matter or issue that arises during the holiday rental period unless the Hirer advises the Owner at the time of their Stay at The Holiday Home. For avoidance of doubt time is of the essence in this respect.

18.2 If the Hirer notices that something is broken or not working properly please tell the Hirer even if it is not causing the Hirer a problem or discomfort as the Owner wants to ensure things are as good as they can be for all guests.
18.3 The Owner will endeavour to organise a mutually acceptable time for any maintenance work but if one cannot be agreed the Owner will instruct maintenance work to be carried out should the need arise. Any such maintenance work will be carried out with consideration to the Hirer and with as little disruption as is reasonably possible. If the hot tub is not available for use at any point during the stay the Owner will refund 10% of the daily tariff for the number of days that it is not available for use.
18.4. The Owner values your custom and wants the Hirer to enjoy the Stay.

19. Data Privacy Statement and Cookie Policy
19.1 See our Privacy Policy here https://www.beachpads.co.uk/privacy-terms/
19.2  See our Cookie Policy here

20. Non-Permissible Activities
20.1 Electric Vehicle charging is not permited.
20.2 Under no circumstances are you to bring electrical appliances into the Holiday Home other than laptops and phone chargers, without explicit written permission. This includes air conditioning units. Guest appliances have not been PAT tested and could invalidate our insurance. We will levy a charge if we find they have been operating without consent.
20.3 Fireworks, Chinese Lanterns, firepits and portable BBQ’s are explicitly forbidden. The whole surrounding area is a SSSI and in Summer the scrubland is capable of easily catching fire if there has not been significant rainfall.
20.4 Whilst reasonable numbers of visiting guests are allowed, additional overnight guests are not. The cottage occupancy limits are clear on the website. This could invalidate our insurance.
20.5 Guests who invite visitors who have dogs, must check with us first. Any visiting dogs must abide by our Doggy Code of Conduct.
20.6 Guests who invite visitors to come and join them during the day are not entitled to use the swimming pool unless explicit permission has been granted. A couple of guests is normally acceptable.
20.7 If you have booked more than one Holiday Home please do not move items either internal or external from one Holiday Home to another. If you would like to move something, a BBQ for example, we can arrange safely moving these and then re-installing them.
20. 8 Drones are not allowed to be flown at Holiday Home. Other guests may be present and we wish to protect their privacy.

20.9 Please read the House Rules and Guidance found on this link https://www.beachpads.co.uk/house-rules/ These House Rules are part of the Conditions of this Contract.

21. Pets
21.1 Pets MUST be booked in and paid for. The fee for pets is £100 /per Holiday Home entered. A maximum of two (2) dogs are allowed in the Holiday Home. We may allow more small or miniature dogs to stay but this must be agreed in writing before arrival.
In order to maintain the Holiday Home to a high standard for everyone to enjoy, it is necessary that guests bringing dog(s) agree to the following conditions.

Terms and Condition for guests bringing their dog(s) to the Holiday Home:
21.2 We ask that your pet has been treated for fleas by a vet prior to your visit. All dog hair shall be removed from the Holiday Home prior to departure and the garden shall be free of dog fouling prior to departure. If pets are allowed, the Owner reserves the right to charge a penalty of One Hundred Pounds (£100.00) should the property be vacated with excess dog hair or should dog excrement be found during inspection of the Holiday Home or its garden and grounds. The Hirer must obey the Countryside Code and keep dog(s) under close control at all times for their own safety as well as for the benefit of other dog owners. Dogs must not chase the Swans and Migrating Birds in the RSPB Reserve.
21.3 When the Hirer brings a muddy dog back from a walk, please clean them off using the outside taps and a dog towel.  On no account use the white towels or beach towels provided for human use.
Dog(s) must not be left alone with free run of the property. If there is a puppy please take extra care to prevent them from chewing the furniture or soft furnishings. Maintaining the Holiday Home is key to the business and it is not always possible to repair items in between guest changes. Such items must be replaced, at your expense. The gates must be kept shut at all times. 

21.4 Dogs are not allowed in the bedrooms or to be in contact with the soft furnishings. Stair gates can be provided for the Holiday Home to help control where the dog(s) can wander in the Holiday Home. 

21.5 Please thoroughly clean the Holiday Home, including dog hair from rugs, before you leave; if properties require additional cleaning or if dogs have been in the bedrooms, or an uncovered sofa, we will charge a £100 fee to cover the cost. 

22. Changes to Booking Terms
22.1        We may revise these Terms from time to time.
22.2       If we have to revise these Terms under clause 22.1, we will give you at least fourteen (14) days written notice of any changes to these Terms before they take effect, or as much notice as possible where your Arrival Date is less than fourteen (14) days before the date of the change.
22.3    If you wish to change the dates of your Booking or amend your Booking in any way, please contact us via our Contact Details. We cannot guarantee that your requests will be accommodated and reserve the right to charge for any differences in price.

23. Other Important Terms
23.1  We may transfer our rights and obligations under these Terms to another individual or legal entity, but this will not affect your rights or our obligations under these Terms.
23.2   Except for you and us, no other person shall have any rights to enforce any of these Terms.
23.3  Each of the paragraphs of these Terms operates separately. If any court or relevant authority decides that any of them are unlawful, the remaining paragraphs will remain in full force and effect.
23.4  If you fail to perform your obligations under these Terms and we do not enforce our rights against you, this does not mean we have waived our rights against you. If we choose to waive any of our rights under these Terms you will be informed in writing.
24.5 These Terms are governed by the law of England and Wales. All parties agree to submit to the non-exclusive jurisdiction of the English courts. However, if you are a resident of Northern Ireland you may also bring proceedings in Northern Ireland, and if you are a resident of Scotland, you may also bring proceedings in Scotland.

We strongly advise you to take out cancellation insurance as once a booking has been accepted; the full amount of rental is due, regardless of cancellation circumstances.
I declare that I am over 25 years old and undertake to take care of the property. I will pay for any damage caused by my party. I will leave the property in a clean, tidy condition. I will return the key as instructed.

Signed………………………………………… Date…………………………………
Print Name…………………………………
Address………………………………

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