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2. Disclaimer
   This application must be signed by a responsible person of the non-profit organization, at least twenty-one years of age, who shall assume full responsibility for any and all damages to the Gazebo and equipment which may be incurred through usage by the group. The below named person shall also be responsible for any costs associated with the use of Town employees.
4. Applicant First Name
5. Applicant Last Name
7. Name of Non-Profit Organization*
9. Address1
11. Address2
13. City
14. State
15. Zip
17. E-Mail Address*
18. What is the best phone number to reach you during business hours?*
20. Date/Time to Use the Town Green/Gazebo
    Date/Time to Use the Town Green/Gazebo Start Date

    Date/Time to Use the Town Green/Gazebo Start Time

    —

    Date/Time to Use the Town Green/Gazebo End Date

    Date/Time to Use the Town Green/Gazebo End Time
21. What is the purpose of your event?
23. Link to:
    Town Green/Gazebo Rules and Regulations
24. Please attach $1,000,000 Certificate of Insurance if Required
26. Electronic Signature*
    Please type your name as confirmation that you have read and agree to the Town Green/Gazebo Rules and Regulations.
27. Date Signed*
    Date Signed*

    Date Signed*
31. FOR OFFICE USE ONLY
33. Authorized Signature
35. Certificate of Insurance Required/Received
37. Process Date
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit Submit and Print

* indicates a required field