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City of Laud�;��1� 1891 Walnut Street • Lauderdale • Minnesota 55113 Phone; (651) 792-7650 Fax: (651) 631-2066 RESIDENT APPLICATION FOR USE OF COMMUNITY PARK APPLICANT INFORMATION: Name: ��,,� 2 K "�CN�� Address: City: Lauderdale State: _MN_ Zip: SS 11� Telephone No.: �-�S \ - IN gq'Ll Name of Organization (if applicable): PARK USE INFORMATION: / Date of Picnic Shelter Use: -\2 - `Z� Hours Used: \ om * Number attending: % * Note: Groups of 50 or more must receive council approval Other park facilities may be reserved (circle all that apply): Ball Field / East or West Tennis Court / East or West Basketball Court / Hours Used: - Volleyball Court /Paved Hockey Rink (Summer) IT Skating Rink (Winter) Hours. Used: (Winter Skating Rinks can, only be reserved from 9-10 p.m. when open skating ends at 9 p.m.) BY SIGNING THIS APPLICATION, THE APPLICANT AGREES TO THE FOLLOWING: • The applicant will clean up the area,after the event has occurred. Please bring your own garbage bags and take garbage with you when you go. • The park facilities may not be used for advertisement of products, goods, or services, or for personal profit. • The proposed event may not unreasonably interfere with the general public use of the, park, or with the safe and orderly movement of traffic on streets surrounding the park. • The applicant is aware of a parking lot on Roselawn Avenue which includes spaces for people,with disabilities. The applicant understands that the park opens at 8 a.m. and closes at 10 p.m. • The applicant can consume 3.2% and intoxicating liquor which they bring to park and keep possession of. • The applicant agrees to carry. a copy of the approved application form with them as proof of reservation. • If the applicant experiences problems with the facilities, the applicant shall contact City Hall during office hours; or Ramsey County Dispatch after hours at 651-767-0640. • The applicant understands that the renter/users of Lauderdale park facilities at all times indemnify,. defend, and hold harmless the City of Lauderdale, Minnesota, its officers, employees, and contractors from and against any and all claims, damages, losses, and expenses of whatever nature, including attorney fees, in any manner connected with, related to, or as a result of any actions or inaction associated with the usage of rental of Lauderdale facilities. Furthermore, renter/users may be required to provide a certificate of insurance ing.the City as an additional insured. cant's Signature Applicant's Printed Name Date Date Application Received: Fees Received: FOR OFFICE USE ONLY: (/ Z 7 � 07 � APProved By: . Check #: Receipt #: Damage Deposit Check #: Non -Intoxicating Liquor License Granted? If so, date Council granted: