Charlestown Park Pavilion Reservation Form printable pdf download

CHARLESTOWN PARK PAVILION RESERVATION FORM

FOR OFFICE USE ONLY

Event Date: ______________ Time Period: _______________ Pavilion # _________________

Group Name: ____________________________________ Function: ____________________________

Rental Date: _______________________________ Time of Use: _____________ to _______________

Applicant Name: __________________________________ # Users:___________ # Cars: ___________

Applicant Address: ______________________________ City: _______________ State ____ Zip ______

Email Address: ________________________________________

Applicant Phone #: _______________________ Phone # at Time of Event: _______________________

See diagram on reverse side to select pavilion:

_____ Pavilion #1 (42 persons) _____ Pavilion #2 (42 persons) _____ Pavilion #3 (42 persons)

Fee: $35.00 Fee: $35.00 Fee: $35.00

_____ Pavilion #4 (78 persons) _____ Pavilion #5 (18 persons) _____Pavilion #6 (18 persons)

Fee: $50.00 Fee: $25.00 Fee: $25.00

(No fee is charged for non‐profit organizations upon proof of 501‐C Status. Security Deposit still applies.)

NOTE: AFTER APPROVAL, BE SURE TO TAKE THIS FORM AND RESERVATION PLACARD TO YOUR EVENT.

In addition to the rental fee, a $50.00 security deposit will be charged per pavilion and is payable when the

reservation is made. Cash or checks will be accepted, with checks made payable to Charlestown Township.

Two separate checks need to be submitted. Security deposit check should be postdated to date of

reservation. If pavilion is left in clean condition, deposit check will be returned within 7 business days.

Reservations must be made 7 days in advance. Rental fee will be forfeited if event is canceled within 7

days of reservation date. Refunds will not be issued due to inclement weather.

Additional approval may be required for group events. Proof of Liability Insurance required.

I have received, read and accept the rules and regulations noted in the attached Ordinance #199‐2016

and the notes on the reverse side of this application form.

Applicant’s Signature: _______________________________________ Date: _____________________

FOR OFFICE USE ONLY ‐ RESERVATION CONFIRMATION

Approved by: _____________________________________ Date Deposit Returned: ____________

Proof of Insurance Provided: _____________

Amount Paid: Rental $______ check # _____ Deposit $_______ check # _____

Charlestown Park Pavilion Reservation Form