Application For Use Of Parks Form - Florence Township

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FLORENCE TOWNSHIP
APPLICATION FOR USE OF PARKS
APPLICANT:
Group/Organization: ________________________________________________________________________
Name of Responsible Person:
Address:
Day Phone Number:
Night Phone Number:
Alternate Contact Person:
Day Phone Number:
Night Phone Number:
FACILITY REQUESTED:
[]
[]
[] John A. Roebling Park a.k.a. FAAD Building & Park +
FAAD Park
Roebling Park at Riverside Avenue
[]
[] H. Kenneth Wilkie River’s Edge Memorial Park
Gazebo at H. Kenneth Wilkie River’s Edge Memorial Park
[] Gazebo at Clark T. Carey Memorial EMS Volunteers Park at Boat Dock
[] Other ________________
+ $25 fee and $150 deposit (higher if non-resident)
* Use of inflatable jumpers, mechanical amusement rides/games, petting zoos, animal rides and anything
deemed dangerous by the Township is prohibited*
DAY & TIME OF REQUESTED USE:
[] Monday [] Tuesday [] Wednesday [] Thursday [] Friday [] Saturday [] Sunday _______________
DATE/S
Hours of use:
Number of people attending event: __________________*
* NOTE: Florence Township to be named as an additional insured for the day when # is over 25.
If necessary: Name of Insurance Company ___________________________________________
Detailed description of use:
As the authorized representative of the above named group or organization making this application, the undersigned agrees to
use the township facilities in accordance with the policies, rules and regulations established by the Township of Florence.
Date:
Signature:
DO NOT WRITE BELOW THIS LINE
===============================================================================
Date Received:
Received by: __________________ Approved: Yes ______ No______
Conditions: _________
Sent to Police Department _____ Public Works ______
Sent to Township Council for approval: yes___ N/A ___
Notes:
Rev. 7/30/07

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