Kenansville Shelter/Open Space Request Form

Park Facility Requesting
Name
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Home Phone - ### - ### ####
Work Phone Work Phone - ### - ### ####
Cell Phone Cell Phone - ### - ### ####
Name of Sponsoring Organization
Email
Shelter/Open Space Requested
Purpose/Use
Requesting The Use of Electricity - if available, select below (if yes, please complete the Electricity Request Form)

Requesting The Use of Electricity - if available, select below (if yes, please complete the Electricity Request Form) Yes No
Requesting access gate open for this reservation - check yes or no below.

Requesting access gate open for this reservation - check yes or no below. Yes No
Reason (i.e. bringing large cooker)
Number of Persons Expected for Event
If charging admission fee, please state amount
Tents & amusements (i.e. bounce houses) cannot be used without written approval from the Town and an insurance policy naming the Town of Kenansville as an additional insured.
Date of Activity Date of Activity / MM / DD YYYY
Hours (list beginning and ending times)
Check any "non-facility" furnishings that you would like to bring (may require approval)

Check any "non-facility" furnishings that you would like to bring (may require approval) Cooker Stage DJ/Sound System Other (please explain) Other (please explain)
Use of Facility Rules & Regulations (please read and sign below)

1. Alcoholic beverages are prohibited
2. User is responsible for any damages incurred during the use of the facility - user must leave facility clean
3. Any and all fees for use of facility must be paid in advance
4. Kenansville Parks & Recreation Department reserves the right to require large groups to obtain extra security personnel.

Town facilities may not be used for buying or selling of goods or services for profit without written permission from the Town Manager.

Any fees charged, including entry fees, must be fully explained. Please complete the field below with this information, if you are charging fees.
Explanation of fees charged (if this applies)
Loud music and noise, which can be heard beyond the immediate area of the picnic shelter is prohibited. This includes radios, record players, loudspeakers, amplifiers, or persons playing musical instruments.

Maximum reservation use of 12 hours unless pre-approved by the Town Manager.
I have read the above rules and regulations and agree to follow them.

Draw your signature into the box below (must be 18 or older)

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date of application Date of application / MM / DD YYYY
Administrator Information

Kenansville Shelter/Open Space Request Form

Use of Facility Rules & Regulations (please read and sign below)

Administrator Information