Rosehill Community Center
304 Lincoln Ave
Mukilteo, WA 98275
PICNIC SHELTER RENTAL FAX 425-353-2457
R:\Rental Packets\Picnic Shelter Rentals\Individual Documents\2020 01 Picnic Shelter Application.doc Page 2 of 2 Page 2 of 2
I have read and agree to comply with all Picnic Shelter Rental Guidelines including the refund policy.
User shall defend, indemnify and hold harmless the City, its officers, officials, employees and
volunteers from and against any and all claims, suits, actions, or liabilities for injury or death of any
person, or for loss of damage to property, which arises out of the use of Premises or from any
activity, work or thing done, permitted, or suffered by the User in or about the Premises, except only
such injury or damage as shall have been occasioned by the sole negligence of the City.
I hereby assume full responsibility for the facility’s use and agree to comply with all rules and
regulations of the City of Mukilteo. The information given in this application is said to be true under
the penalty of perjury by the Laws of the State of Washington and regulations of the City of
Mukilteo. I understand the City of Mukilteo reserves the right to deny use, change, or cancel any
part of this Picnic Shelter Application and any related scheduled activities.
Rental Approval (For City Use Only)
Approved by:_______________________________ Date: ________________________
Renter has received rules and guidelines. Date: ________________________
Reservations are made once application and payment are received.
Space cannot be reserved without payment.
Complete the application form and return it in person, by mail, FAX or email to
email@example.com. We accept the following forms of payment: cash, check, Visa, M/C, or