TOWN OF RUSSIA

APPLICATION FOR USE OF KUYAHOORA TOWN PARK

This application is being made with the understanding that the applicant has read, acknowledges and understands the Rules and Regulations of the Town of Russia, and will comply with the same.

To be filled out by the applicant:

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DATE OF USE REQUESTED TIME OF USE

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APPLICANTS NAME GROUP/ORGANIZATION REPRESENTED

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STREET ADDRESS ADDRESS OF ORGANIZATION

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CITY / STATE / ZIP CODE CITY / STATE / ZIP CODE

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TELEPHONE NUMBER TELEPHONE NUMBER

_________________________ ________________ ________________

Applicants Signature Resident Non-resident

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TO BE FILLED IN BY TOWN REPRESENTATIVE ------ TOWN CLERK

DEPOSIT PAID __________ CHECK # __________ DATE PAID ______________

USE FEE PAID __________ CHECK # __________ DATE PAID ______________

DATE OF INSPECTION _________________ BY WHOM _________________________

DEPOSIT CHECK WAS: RETURNED ________________ NOT RETURNED _______________

APPLICATION, DEPOSIT AND USE FEE WAS RECEIVED BY: ____________________________

Town Representative

The Town Clerk will accept applications for use of the Town Park Pavilion beginning January 2 nd of the year requested, and will take them on a first come, first served basis.

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TOWN PARK PAVILION AGREEMENT

This Agreement is granted under the following conditions; violation of which shall cause the Park to be closed, all parties to leave and a fine of up to $ 500.00. Also, if a security deposit is involved, it will be revoked.

1. A deposit of $ 50.00 will be paid to the Town Clerk upon reserving the Pavilion. This deposit will be refunded in full, if the pavilion and other facilities used are found to be in satisfactory condition by the Park Staff.

2. Requested dates are confirmed only upon the receipt of the application and deposit fee, which must be received by the Town Clerk within 15 days of verbal requests. If you need to cancel, it must be done 15 days in advance, and the Town Clerk must be notified in writing, or the deposit check will be kept.

3. The organization / individual who executes the Rental Agreement must be at the Park and available if required by the Town or any law enforcement agency. Any damage to the Town property, and any fines imposed, will be the responsibility of the sponsoring organization / individual.

4. The Park Pavilion shall be open from Memorial Day to Labor Day each year between the hours of

9 AM to 9 PM. Use of the Pavilion beyond these hours is prohibited unless an extension is granted in writing on this form, and passed by the Town Board. No music shall be played after 9 PM unless an extension is granted.

5. No connection to the electrical service is permitted other than that for which an electrical outlet has been provided by the Town.

6. Weapons, including firearms, bows and arrows and any other instruments that may be classified as weapons along with fireworks, explosives and dangerous instruments ( as defined by Penal law), are forbidden within the Park at any time.

7. No ox, pig or other similar type of roast is allowed, unless a special permit from the Town is granted. All tables and other park equipment will remain at the same location, both before and after the rental event.

8. No vehicles shall exceed 10 m.p.h. in Park, at any time.

9. No bashes, or other parties involving "Battle of the Bands" is permitted unless Special Permit is granted. Complaints of excessive noise or bad conduct shall be grounds for the closing of the Park.

10. There shall be NO ALCOHOLIC BEVERAGES brought onto the Park property for consumption at the Park, at any time.

11. All persons must be out of the Park by 1/2 hour after the closing time.

12. BRING YOUR OWN CONSUMABLES (Garbage bags, paper towels, toilet tissue, etc.) Empty all garbage cans, insert new liners, and put all bagged garbage in the DUMPSTER.

13. The KITCHEN should be left in a clean condition, ready for the next use. If the GRILL is used, clean the top and remove the grease out of the trap. Use the refrigerator labeled for the Town Park use only!!! (Next to the Grill) IF THE FACILITIES ARE NOT PROPERLY CLEANED, a cleaning charge will be billed to the individual requesting the usage of the Park Facilities.

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REMEMBER, IT IS YOUR PARK----PLEASE TAKE CARE OF IT

CHECK THE FACILITIES YOU ARE REQUESTING TO USE

PAVILLION __________ KITCHEN __________

SOCCER FIELD __________ BASEBALL FIELD __________

PLAYGROUND __________

The undersigned agrees to abide by these rules and regulations.

______________________________ ______________________

Signature of Individual or Organization Represented Dated

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TOWN BOARD / PARK USE ONLY

_______________APPROVED _______________DISAPPROVED ___________________REASON

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AUTHORIZED SIGNATURE DATE