edwardsville parks and recreation - City of Edwardsville

Home Phone # ( ) _____-______ Cell # ( ) _____-______ Email ... Time ______:______a.m. / p.m. TO ______:______a.m. / p.m. (include set up and tear down).
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Edwardsville Parks and Recreation 118 Hillsboro Avenue, P.O. Box 407, Edwardsville, IL 62025 Special Event Permit Application # __________ This application must be filled out in entirety for your reservation to be considered. All applications are considered on a first come first serve basis, with City sponsored events taking priority. All fees required shall apply to defer any utility, maintenance, repair and personnel costs incurred as a result of said permitted use. FEES ARE NON- REFUNDABLE. The Recreation, Arts, & Special Events Board reserves the right to reject any application and to waive any fee required. Applicant must complete the following application and return it with proper fees at least two (2) weeks prior to requested use. Community Events must be received for review ninety (90) days prior to the requested event date.

Applicant Name ______________________________________ Age ______ Date of Birth ______/______/________ *Organization Name __________________________________ IRS 501(c) Tax Exempt # _______________________ Address ____________________________________________ City/State/Zip ________________________________ Home Phone # (

) _____-_______ Cell # (

) _____-_______ Email __________________________________

Nature of Event _____________________________________ Date Requested for Event ______/______/________ Total Reservation Time ______:______a.m. / p.m. TO ______:______a.m. / p.m. (include set up and tear down) Actual Event Time ______:______a.m. / p.m. TO ______:______ a.m. / p.m.

Expected # of attendees _______

* All organizations are required to provide a copy of insurance naming the City of Edwardsville as additional insured.

Park/Facility Requested: Please check appropriate park or facility you wish to reserve. Non-resident fees apply to all applicants outside of Edwardsville city limits. This fee must be included for your application to be considered.

Joe Glik Park: Rotary Pavilion

______ Resident: $100 ______ Non-Resident: $150

Joe Glik Park: Gugger Pavilion

______ Resident: $60 ______ Non-Resident: $100

Leclaire Lake: Madison Ave. Pavilion

______ Resident: $60 ______ Non-Resident: $100

Leclaire Lake: Gazebo

______ Resident: $60 ______ Non-Resident: $100

City Park Bandstand

______ Resident: $60 ______ Non-Resident: $100

Leon Corlew Park: Playground Pavilion ______ Resident: $100 ______ Non-Resident: $150 ~ (10:00am-3:00pm or 4:00pm-9:00pm) ~ FOR SPLASH PAD RENTALS PLEASE USE LEON CORLEW PARK SPLASH PAD RENTAL FORM Other: ___________________________________________________ (please call Parks staff member for pricing) Requested Event Needs-Please check ALL that apply. _____ Picnic Reservation

_____ Bandstand Use

_____ Charity Event

_____ Wedding

_____ Restrooms

_____ Electricity

_____ Alcohol Served

_____ Cooking/Food Served

_____ Litter Receptacles

_____ Lake Use

_____ Security Fence

_____Decorations/Sign/Display

_____ Amplified Sound

_____ Fireworks

_____ Tent Placement

_____ Carnival Rides

_____ Inflatable Rides

Other (Specify) __________________________________________________________

Edwardsville Parks and Recreation 118 Hillsboro Avenue, P.O. Box 407, Edwardsville, IL 62025

Special Event Permit Application # __________ (Pg 2) HOLD HARMLESS AGREEMENT THE APPLICANT IS RESPONSIBLE FOR INFORMING THE GROUPS MEMBERS OF THEIR DUTIES AND RESPONSIBILITIES UNDER POLICIES AND PROCEDURES. 1. It is understood and agreed that the City, it's Mayor, City Council, R.A.S.E. Board, employees, volunteers, and agents shall be held harmless against all claims, damages, loss or expenses including attorney's fees arising out of or resulting