Form Center

2. Group name
4. Applicant Name*
   Must be over 21 years of age and must be present during the event.
6. Address*
8. City*
9. State*
10. Zip*
12. Daytime Phone*
13. Evening Phone
14. Cell Phone
16. Email Address*
18. Park Requested

    Please select all that apply.

    1. Hurkamp Park
    2. Memorial Park
    3. W.L. Harris
    4. Maury Playground

    1. City Dock
    2. Washington Monument
    3. Washington Ave Mall
    4. Dog Park

    1. Riverfront Lawn & Plaza
    2. Canal Path/Heritage Trail
    3. Dixon Park

    1. Cossey Park
    2. Motts Reservoir (specify below):
    3. Other Area (specify below):
20. Other Area
    Please list which other area not listed here that you are interested in.
22. Associated with a special event?

    1. Yes
    2. No
23. If so, which one?
25. Date of Event*
    Date of Event
26. Time of Event*
    Time of Event Start Time

    —

    Time of Event End Time
28. Description of Event*
30. Setup/Cleanup Times*
32. Will you need electricity?*

    1. Yes

    1. No
33. For what equipment?
34. Will you need water?

    1. Yes
    2. No
36. Open to the Public?*

    1. Yes

    1. No
37. Estimated Attendance
39. Who will benefit from this event?
41. Equipment to be brought in by Renter
43. Equipment to be rented from FPRE
45. CANCELLATION must be in writing 24 hours in advance of date reserved (phone calls are not acceptable). Refunds will be made for severe weather or hazardous conditions at the Park. NO refunds will be given for “No Shows”. Refunds will only be made through the office at the Community Center.
    
    If using the Canal Path / Heritage Trail the event planner may submit 4 copies of their 8.5” x 11” laminated event flier to Fredericksburg Parks, Recreation & Events Department for display in the City Trailside Kiosks (4 locations along the trail). Fliers are to be submitted to the Fredericksburg Parks, Recreation & Events office no less than one month prior to the event for display in the kiosks.
    
    NO vehicles on the park grass (regardless of which park) without specific written permission by Parks, Recreation and Events Department.
    
    The Applicant hereby agrees and undertakes to save and hold harmless, the City of Fredericksburg from any and all claims for damages to person or property, that may arise out of the use of the facility, specified above, without regard to whether the damage, personal or otherwise, is brought about or caused by the negligence of the applicant, the City of Fredericksburg, or any other person, organization, firm or corporation.
    
    The Applicant will be responsible for, and agree to pay for, damages done to the property & equipment of the City, exclusive of ordinary wear and tear. Any equipment brought into the park must be removed in a timely manner or the applicant risks being subject to additional charges.
    
    The Applicant will be responsible for the actions and behavior of ALL persons involved with, or located at, the park during the scheduled hours of the activity, to include underage drinking. Any violation of the General Park Policy may result in forfeiture of the security deposit and additional charges to the applicant.
    
    Applicant is responsible for securing ABC license, if applicable, must have a copy on file at the Community Center ten days prior to the event, and must have a copy available upon request during the event.
47. Applicant has read and will abide by the General Park Policy.
    Applicant's Signature: I understand that checking the box below is the equivalent of signing my name.*

    1. I Accept
49. Applicant - Full Legal Name*
50. Date*
    Date
54. Rental Fee
55. Deposit
56. Date Paid
    Date Paid
58. Additional Charges
59. Permit #
61. Notes
63. Staff Initials
64. Staff Remarks
66. Copy of Permit in Park Maintenance Box

    1. Yes

    FAX if less than 48 hours to 361-4085, Attn: Aaron
67. Date
    Date
68. By (Staff)
70. Approved for Refund
    Staff Name
71. Amount of Refund
72. Date Submitted
    Date Submitted
Leave This Blank:


74. 1. Receive an email copy of this form.
75. Email address

    This field is not part of the form submission.

76. Submit Submit and Print

* indicates a required field