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PAVILION USE APPLICATION
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FACILITY USE APPLICATION/AGREEMENT - NORTHWEST PARK PAVILION

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________________________________________________________________________________
_____________________________________________________________________________________________

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 860-647-3084
EMERGENCY CONTACT: Rob Topliff - pager 939-0791 (leave your phone no.)