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