Fillable FACILITY USE REQUEST FORM (Village of Wasingtonville)

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FACILITY USE REQUEST FORM (Village of Wasingtonville)

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FACILITY USE REQUEST FORM
All requests for Facility Use must be submitted not less than 4 weeks prior to the event. You
will be notified of the approval or denial of your request via email and/or phone. If you have
questions, please call 845.496.3221.
Group/Organization:
Type of Activity/Event:
Contact Name:
Mailing Address:
Phone:
Cell:
Email:
S
elect Park/Location Requested for Event:
c L. Vern Allen Park
c Memorial Park
c Municipal Lot
@29 W. Main St.
Date(s) Requested:
Time(s) Requested:
**INCLUDE TIME
NEEDED TO SET UP**
P
lease attach a copy of your Certificate of Liability Insurance with the Certificate Holder
listed as follows:
Village of Washingtonville
9 Fairlawn Drive
Washingtonville, NY 10992
Documents can be mailed/hand delivered to the above address or emailed to Village Clerk
Christine Shenkman at Christine@washingtonville-ny.gov
12.29.2020
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FACILITY USE REQUEST FORM (Village of Wasingtonville)

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Completed 25 January 2021

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