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LOWER PAXTON TOWNSHIP PARKS & RECREATION DEPARTMENT (Lower Paxton Township)

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The LOWER PAXTON TOWNSHIP PARKS & RECREATION DEPARTMENT (Lower Paxton Township) form is 2 pages long and contains:

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  • 4 check-boxes
  • 38 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Lower Paxton Township

BROWSE LOWER PAXTON TOWNSHIP (PA) FORMS

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LOWER PAXTON TOWNSHIP
PARKS & RECREATION DEPARTMENT
425 PRINCE STREET, SUITE 170, HARRISBURG, PA 17109
717-657-5600 www.LowerPaxtonParksandRec.com
2021 SPECIAL EVENT / TOURNAMENT PERMIT APPLICATION
Name of Event: ____________________________________________________________________________
Event Description: ____________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Event Day/Date (s): ___________________________________ Event Time: From______________ To______________
Park Location:______________________________________________ Estimated Attendance: ____________________
Event Sponsor: ________________________________________________________________________ For Profit / Non-profit
Event Representative Name: ______________________________________________ Lower Paxton Twp. Resident: Yes / No
Address: _______________________________________________________ City/Zip: ______________________________
Telephone: (Day) _______________________ (Evening) _______________________
Email Address: ____________________________________________________________________
Contact person on site during event time: ____________________________________ Cell #: _________________________
Liability Insurance: A signed certificate of general liability insurance naming Lower Paxton Township as additionally insured and
carrying a minimum of $1,000,000 per occurrence is required with application.
Event Application Fee: $125.00 per day
Note: Additional applications and fees for park facility rentals may apply
Will any fields/ball courts/ pavilion be needed? ____ If yes, describe: ________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Will there be additional equipment such as entertainment systems, animals, carnival and water activities? ____ If yes, describe:
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Will there be any food for sale or given for free? ____ If yes, describe: _________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Will there be any other goods or services for sale? _____ If yes, describe: _______________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Page 1 of 2 OVER ->
For Office Use:
Permit #: ___________ Fee: $_______
Liability Insurance Provided? ________
Permit Issue Date: ______________
Director Initials: _______________
Please attach a sketch / drawing of the site layout and /or route map.
Return application payment, site layout, and proof of insurance to Lower Paxton Township Parks and Recreation Department,
along with this completed form to apply for a permit. All requests must be received at least 60 days prior to the event date.
I certify that all information on this application is true and correct to the best of my knowledge.
Applicant Signature: _________________________________________________ Date: __________________________
Page 2 of 2 Business Office>Parks & Pavilions>2021
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LOWER PAXTON TOWNSHIP PARKS & RECREATION DEPARTMENT (Lower Paxton Township)

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Completed 1 February 2021

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