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Lino Lakes Parks and Recreation Department <br /> 7204 Lake Drive <br /> C I T Y O F Lino Lakes, MN 55014 <br /> LlN KE.S1 (612) 780-1885 Fax (612) 784-7227 <br /> Circle-Lex Lions / City of Lino Lakes <br /> Party Wagon Application <br /> This application form must be filled out completely and submitted with applicable fee (if any) and <br /> $200 damage deposit at least 5 working days prior to requested date. Refer to Reservation <br /> Procedure sheet for further information. The person submitting the application must be an adult. <br /> Applicant Name <br /> Applicant Address <br /> Street City Zip Code <br /> Applicant Day Phone Applicant Evening Phone <br /> Date of Party . <br /> Please list any alternate days if requested date is not available <br /> Exact Location of Party Wagon To Be Delivered <br /> Requested Time of Delivery(between 8:00 am-3:00 pm) An adult must be present at <br /> Requested Time of Pick Up(between 8:00 am-3:00 pm) both time of delivery andtime of pickup. <br /> Is this application for ( ) Block Party or ( ) Individual Gathering? (see below for descrip- <br /> tion) Any misrepresentation of application status will result in forfeiture of damage deposit and <br /> revocation of opportunity to submit application in the future. <br /> Block Party—A neighborhood gathering , located in the service area, of at least 5 families who <br /> reside in the same neighborhood. See back of this form for the eligible service area. <br /> Individual Gathering —A property owner, located in the service area, who is hosting an event (ie. <br /> birthday party, graduation, family reunion). See back of this form for the eligible service area. <br /> If Block Party, please list names, addresses, and phone numbers of four(4) other families: <br /> Name Address Phone Number <br /> 1 <br /> 2 <br /> 3 <br /> 4 - <br /> By signing this application, applicant acknowledges and agrees and specifically states that <br /> he/she has read and understands all policies, rules, and regulations relating to the Party <br /> Wagon and does hereby agree to defend and hold harmless the Circle-Lex Lions Club and <br /> the City of Lino Lakes from liability in case of accident or injury. <br /> Applicant Signature Date <br /> ice Usa Qnly Qarnaga Dep© itr';$ QQ Check <br /> Data Appllcot►Reed Rst3ta(Fee Cheek# <br /> approved <br /> turned <br /> D 'Cs�n#irrnabQr� etd/ Icai?on and fla ?ap�stt ReuCctec! 4111a <br />