edwardsville parks and recreation - City of Edwardsville

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Home Phone # ( ) ______-______. Work # ( ) ______- ... I further attest that I will be personally responsible for repair
Edwardsville Parks and Recreation 118 Hillsboro Avenue, P.O. Box 407, Edwardsville, IL 62025

Edwardsville Glen Carbon Community Pool Rental Form 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.

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

) _______-_______

Work # (

) _______-_______

Email ____________________________________________

Cell # (

) _______-_______

IL Driver’s License # ___________________________

Nature of Event _____________________________________ Date Requested for Event ______/______/________ Expected # of attendees _______ * All organizations are required to provide a copy of insurance naming the City of Edwardsville as additional insured.

Pool private rentals are only allowed Tuesday – Sunday from 6pm-8pm Rental Fee: $175 (resident) $250 (non-resident)             

Pool rentals are limited to 100 people On site during the rental will be 2 lifeguards and 1 supervisor. Children must be supervised by adults at all times. All participants must conduct themselves in a courteous, safe and family oriented manner. Swim suits and/or appropriate attire must be worn at all times. No smoking or alcohol allowed in or around the pool Swim diapers are required for all un-potty trained children. Outside food and drink is allowed but will be restricted to certain areas of the pool deck. Limited decorating is allowed and must be approved by staff. The shuttle will not be in service during rentals For rentals only, parking is allowed in the parking lot right beside the pool house and in staff parking. All pool rules will apply during rentals. The pool may be closed at any time due to weather, maintenance or other operational concerns.

Note: The person applying for permit shall be responsible for any and all damages to personal and public property which may occur as a result of the requested use. Permit is valid only for dates and times listed, and must be posted on site during the event.

Edwardsville Parks and Recreation 118 Hillsboro Avenue, P.O. Box 407, Edwardsville, IL 62025 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 from the use of this facility. 2. Each group shall be fully responsible for the physical condition in which they leave the facility. The expenses resulting from any damage or undue maintenance shall be charged to the applicant. Failure to meet any obligations beyond deposit amount within thirty (30) days of billing will be cause for cancellation of future privileges and for legal action including all costs incurred by the City for collection. 3. Alcohol is prohibited on all park property. 4. I have read, understand, and agree to comply with all the rules, regulations, policies, and fee schedules, as set forth by the City of Edwardsville. I further attest that I will be personally responsible for repair or damage to equipment, the facilities, and grounds or for replacement of stolen equipment. 5. I agree to be responsible for the conduct of our group in and about the facilities in use, for the control and containment of noise, group participants, litter and damage beyond ordinary wear and tear, which may occur while we are occupying the premises. I further agree that use of the requested facilities shall be in accordance with Policies and Procedures, local ordinances, and all valid laws of the State of Illinois. *____ I am over 21 years of age. *____ I agree to adhere to all policies set forth by the City of Edwardsville. *____ All information, to the best of my knowledge, provided on this form is truthful. * Applicant must initial all statements above. Applicant Signature _______________________________

Today’s Date _____/_____/_____

If paying by check: Make checks payable to Edwardsville Parks & Recreation Amount Due $ ________ If paying by credit card: Amount Due $ ________ + $4 if paying by credit card. _____ Visa

_____ MasterCard

Total Amount Charged to Card $ ___________

Card # _____________________________

Cardholder Name _________________________________

Expires_____/_____/_____

Signature __________________________________

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Office use only Fee(s) Received $ __________ Check # __________ Insurance Received _________________________ Approved By ______________________________________

Date Approved ______/______/_____