PRINT OUT THIS FORM AND RETURN TO THE PARKS DEPARTMENT 116 WEST ADAMS (CITY HALL)

PO BOX 449

CRESTON, IA 50801

FOR FUTHER INFORMATION PHONE 782-2000 EXT. 2

City of Creston

Park & Recreation Department

Park Use Application Form

Please print the form below.

Applicant information: _______________________________________________________

(name)

___________________________________________________________________________

(address) (city, state, zip code) (phone #)

Location of City property:_____________________________________________________

Date of Event (Use): _______________________ Time(s) of Event: __________________

Description of Event (Use): ___________________________________________________

___________________________________________________________________________

___________________________________________________________________________

(Please note: Keg beer is not permitted on any City property.)

The undersigned certifies that all above information is true and hereby accepts full responsibility for compliance of all individuals in the group with the City of Creston Park rules and regulations. The undersigned agrees to make financial restitution to the City for any damage to or loss of City property or equipment caused by the above named group or any individual present at this event. Furthermore, the undersigned does hereby release and hold harmless the City of Creston, its elected officials, employees and volunteers from any and all claims or loss resulting in bodily injury or property damages caused by the undersigned or any third party present at this event. Furthermore, the undersigned agrees to financial reimbursement to the City if additional cleanup is necessary by the park employees. The City reserves the right to cancel arrangements in case of emergencies with or without notice.

_____________________________________ ________________________________

Signature of Applicant Date

_____________________________________ ________________________________

Approved by: Date