11-06-2017 Park Commission Packet

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4MI-Q!w 7— FOR OFFICE USE ONLY Park Facility Use Permit Amount Due: City of Orono Date Paid: 2750 Kelley Parkway ] Check # Orono, MN 55356 [ ] Cash Receipt # Phone / 952.249.4600 Staff Initials: r�kES H O4� Park Facility Use Permit fee is $15.00 per date for a City of Orono RESIDENT individual, business or organization; or $25.00 per date for a NON-RESIDENT individual, business or organization. Fees may not be waived for non-profit organizations. • Complete this permit application form and submit to City Hall with your park reservation tee prior to the requested date. No application will be considered complete unless submitted with the applicable permit fee. A permit will be issued provided there is no scheduling or policy conflict pertaining to the date or facility requested. Name of Park Facility Requested Describe the Use/Event Estimated # of Participants Expected Event. Dates/Times Proposed ** List all Event Dates/Times Below ** Day of Week Date Arrival Time Departure Time Permit Holder -- Applicant / Organization Information Applicant / Organization Is: [ ] A City of Orono Resident Individual, Business or Organization - $15.00 Per Date Requested [ ] A Non -Resident Individual, Business or Organization - $25.00 Per Date Requested Applicant Na Alternate Phone Email Address Organization Name (IF APPLICABLE) Address City, State, Zip Daytime Phone Applicant Signature The person(s) and or organization(s) using City of Orono facilities, by signing and accepting this permit, agree to indemnify, defend, and hold harmless forever the City of Orono for any damages to City property by any participant or public involved and agree to assume liability for injury or death of any participant or public involved. Any damage to facilities or equipment shall be reported immediately. The undersigned also agrees to accept responsibility for observance of the rules and regulations of the City of Orono. If an agent of an organization above-named, the undersigned certifies that he/she is authorized to accept responsibility of the duties of the permit holder on behalf of the organization. X Signature of Applicant Date This permit must be on user's person while in the park and made available to City personnel upon request. Violations of park ordinances are misdemeanors and can result in revocation of permit. Use and consumption of alcoholic beverages on park property is prohibited by City ordinance.