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Facility Use Reservation Form
City of Zephyrhills
Parks & Recreation Department
Facility Use Reservation Form
___ Krusen Football ___ Krusen Softball Field(s) ___ Zephyr Park Tennis ___ Other Facility
State other:
Name of applicant (User):__________________________________________________________________________________
If an organization, name of representative: ____________________________________________________________________
___ Not-for-Profit (attach copy of 501c3 certificate) ___ Government Agency ___ City Co-Sponsored
Address: _______________________________________ City: _________________ State: _____________ Zip: ___________
Contact Person: Day Telephone: _____________________ Contact Person: Evening Telephone: _________________________
Alternate Contact Telephone: ________________________
Description of Event: ______________________________________________________________________________________
Anticipated attendance: ______________ Attendees will be: _____ Adult _____ Teen _____ Preschool
If youth event, number of supervising adults: _________
Day(s) of event (check all that apply): ___ Mon. ___ Tues. ___ Wed. ___ Thurs. ___ Fri. ___ Sat. ___ Sun.
Start date of event: ______________ Time event begins: _______ End date of event: __________ Time event ends: _________
Will event be open to the general public? ___ Yes ___ No Admission/donation/fee ___ Yes ___ No Amount $ _____________
Food/merchandise sales? ___ Yes ___ No Description: __________________________________________________________
Refreshments served? ___ Yes ___ No Description: ___________________________________________________________
Number of paid security officers (if applicable): _______ Scheduled time (from-to): ____________________________________
User Fees: User fee(s) for the requested facility shall be based on the rate of $ _________ (Plus Florida sales tax, if applicable) for the period set forth in this application. If applicable, each additional hour or part thereof, and the cost of additional equipment, supplies and services, will require additional fees.
Applicant/User Signature: Date:
Reservation Approved by: Date:
Insurance Required: ____ Yes ____ No Certificate naming "City" as "Additional Insured" attached? ____ Yes ____ No
Notarized background check forms attached? ____ Yes ____ No
Facility Use Agreement attached? ____ Yes ____ No
Responsible party has read and understand the Facility Use Policy: ____ Yes ____ No
Required attachments to accompany this completed Use Form: (1) Current Insurance Policy (2) Notarized Background Check Forms (3) completed / signed Facility Use Agreement.
Revised 11/10
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James Lyon
Parks and Facilities Superintendent
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Parks & Recreation
Phone: 813-780-0022, ext. 3563