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FACILITY USE APPLICATION/AGREEMENT - NORTHWEST PARK PAVILION
Pavilion Rules and Regulations
RENTAL FEE DUE WITH APPLICATION TO RESERVE DATE.
APPLICANT/ORGANIZATION__________________________________________________________________
ADDRESS_____________________________________________________TELEPHONE___________________
_____________________________________________________
PERSON RESPONSIBLE FOR ACTIVITY________________________________TELEPHONE_______________
DATE TO BE USED______________________________NUMBER OF PEOPLE EXPECTED_______________
EXPLANATION OF WHAT THE FACILITY WILL BE USED FOR:____________________________________
_____________________________________________________________________________________________
PAVILION OPEN AT __________ ACTIVITY BEGINS AT___________ ACTIVITY ENDS AT_____________
RENTAL OF GRILL REQUESTED _____ YES _____ NO
WILL AT LEAST 51% OF ATTENDANCE BE MANCHESTER RESIDENTS ____ YES ____ NO
WILL TICKETS, ADMISSION, FEES, PLEDGES OR DONATIONS BE COLLECTED FOR THIS EVENT? ____ YES ____ NO
IF YES, EXPLAIN_________________________________________
ARE SALES OR MONEY TRANSFERS PLANNED TO TAKE PLACE AT THIS EVENT?
____YES ____ NO IF YES, EXPLAIN____________________________________________________________
It is understood that use of the facility is subject to the Pavilion Fee Schedule, all Pavilion reservation requirements and all Pavilion rules and regulations. These are being provided with this application agreement form. I agree to hold the Town of Manchester harmless and indemnified and to protect the Town from any claim or damages of any nature whatsoever resulting from the use of said premises by me, my agents, representatives, invitees or any other person, including but not limited to, any expense (including attorney’s fees) in defending any such claim or claims, and including the repair of any damage to Town property.
SIGNATURE______________________________________________________DATE______________________
ADDRESS________________________________________________________PHONE_____________________
******************************FOR DEPARTMENTAL USE ONLY********************************
A Pavilion rental fee of __________ is charged. Additional fees charged are________________________________
Total amount due_______________
Fee received by______________________________________________________ Date______________________
Application approved ____Yes ____No By_____________________________ Date_____________________
Staff Comments________________________________________________________________________________
_____________________________________________________________________________________________
RENTAL FEE DUE WITH APPLICATION TO RESERVE DATE.
Please make checks payable to the "Town of Manchester".
Send to: Recreation Dept., Town of Manchester, 41 Center Street, Manchester, CT 06040
For further information please call 860-647-3079
EMERGENCY CONTACT: Rob Topliff - cell 930-8469
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