Application Form To Hold A Special Event printable pdf download

APPLICATION TO HOLD A SPECIAL EVENT / ACTIVITY

Division of Parks and Recreation, ODNR

INSTRUCTIONS:

1. This application must be submitted directly to the park office at least 21 days in advance.

2. A processing fee of $40.00 will be charged for all permits issued by the division chief unless the

event is co-sponsored by the park. The permit fee may be increased to cover direct costs of the

event to the division for additional personnel, utilities, etc., or when food or other items are sold.

Exempt from this fee are fishing tournament events which have been approved by the park manager.

3. All division rules shall remain in effect except as specifically exempted by the permit.

4. The applicant and/or event sponsor(s) must agree to indemnify and hold harmless the State of

Ohio (and the United States of America at federal sites) and any of their respective employees or

agents from any and all liability for any loss, costs, injuries, or damages resulting from the event.

5. The applicant certifies that he or she is at least 18 years of age and has the authority to act in an

official capacity for any named event sponsor in signing this application.

I agree to all the statements listed above: __________________________ _____________

Signature of applicant

date

Applicant should complete this section and attach any additional information as appropriate.

NAME OF STATE PARK (and specific event site): ______________________________________

NAME OF EVENT: ______________________________________________________________

DATES AND TIMES OF EVENT OR ACTIVITY: ______________________________________

EXPECTED NUMBER OF PARTICIPANTS:__________ # OF SPECTATORS:______________

BRIEFLY LIST ALL ACTIVITIES THAT ARE INCLUDED IN THE EVENT:

______________________________________________________________________________

LIST BELOW ANY ITEMS OR FOOD OR BEVERAGES TO BE SOLD OR GIVEN AWAY:

_______________________________________________________________________________

INDICATE AMOUNT OF REGISTRATION OR ENTRY FEE (if any): ___________________

(If any type of registration or entry fee is to be charged, see note on reverse re: liability insurance.)

CONTACT PERSON:______________________ EVENT SPONSOR(S): ____________________

(Please type or print)

Daytime phone number (____)________________ Evening phone number (____) ______________

ADDRESS:_____________________________________________________________________

Street

City

State

ZipCode

Application Form To Hold A Special Event