Parks Department
Facility Reservation Request
NAME OF APPLICANT/ GROUP: _____________________________________
ADDRESS________________________________________________________
TELEPHONE (Home) ___________________ (Work) ____________________
EMAIL ADDRESS: _________________________________
ADDRESS________________________________________________________
TELEPHONE (Home) ___________________ (Work) ____________________
EMAIL ADDRESS: _________________________________
Groups
should provide the above contact information for at least two people.
FACILITY REQUESTED:____________________________________________
DATE (attach list for multiple dates/times):
________________________________
HOURS: ___________________________________________________________
PURPOSE: _________________________________________________________
___________________________________________________________________
SPECIAL REQUESTS:_________________________________________________
___________________________________________________________________
# Participants ___________ # Adults _________ Age range of children
__________
Are participants charged a fee?
Yes No
If so, how much? $_______________________
I (We) assume full responsibility for any damages to Township
equipment and/or property that occur as a result of the requested use. Furthermore,
I (We) understand that Pocopson Township, its staff, and members of the Parks
Department will not be held liable for any injury or damage which may occur to
me, my guests, and/or members of the above-named organization and our property
during our requested use of the facility. All applicants must provide a
Certificate of Insurance, naming
SIGNED: ______________________________________________________ DATE:
_________________
TITLE:
_________________________________________________________________________________
TWP APPROVAL (Signature & Date)
_______________________________________________
FEE $_________________ Date
issued _______________________________
CERTIFICATE OF INSURANCE RECEIVED: _____________________________
Park and Park Facilities
1) Adult organizations or instructional groups of fifteen (15) or more persons shall pay a fee on behalf of that organization or group for the facility or facilities requested in accordance with the following fee schedule:
a) Ball fields – per use $40
b) Ball fields – per season (one evening weekly for 20 weeks) $750
c) Tennis court – per use per 3-hour period $30
d) Volleyball court – per use per 2-hour period $25
e) Basketball court – per use for 3-hour period $30
f) Soccer field – per use for 3-hour period $40
2) Youth organizations or instructional groups (Little League, youth soccer programs, etc.) shall pay a fee on behalf of that organization or instructional group for the facility or facilities requested in accordance with the following fee schedule:
a) Ball field – per day $10
b) Soccer field – per day $10
c) Tennis court – per day $10
d) Volleyball court – per day $10
e) Basketball court $10
3) Pavilion and Grills
a) Residents $0
b) Nonresident for personal use $50
c) Nonresident for business use $100