Fillable Making a Reservation Cancelations-If canceling your party, please (City of Winchester)

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Making a Reservation Cancelations-If canceling your party, please (City of Winchester)

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Making a Reservation
• Dates for reservation are from September-April.
• Date and time of the rental is Saturday’s 5:30-8:00pm (room rental) and 6:30-8:00pm (gym time)
• Payment is due at the time of reservation.
• Cancelations-If canceling your party, please notify staff the Friday before your party. You
can call 540-662-4946 or email Stephanie.frazier@winchesterva.gov.
• No shows or failure to communicate change of plans-parties will be responsible for
FULL payment of rental, no refunds given.
PB&J Equipment Usage and Rules
• Do not enter into the gym until staff has notified you that the equipment is set up and ready for
your use.
• Sneakers and socks only while on the play equipment.
• No food is allowed in the gym area.
• Keep puzzle flooring attached and on the floor. Do not move the flooring to another
location.
• This equipment is for ages 5 and under. Older siblings can attend the party but must stay
off the equipment.
General Rules for Use of the Facility
• Posting of any signage or balloons on trees, posts, fencing, light poles, and gates is
prohibited.
• Applicant agrees to reimburse the City of Winchester for any damage of public property
as a result of the user’s use of the facility. Decorations shall not be taped, nailed, stapled
or fixed in any way to walls, doors, glass, lights, electronic equipment, or ceilings.
• All facility users shall not exclude anyone in participation, deny anyone benefit of, or
otherwise subject anyone to discrimination because of the person’s race, color, national
origin, age or disability.
• Applicant is responsible for compliance with Americans with Disabilities Act, as it
relates to the event, performance, and services to be provided in relation to the event for
individuals with disabilities.
• Applicant hereby guarantees and assumes full and exclusive responsibility for the safety
of persons and property of all participants and activities including, without limitation,
players, participants, staff, officials, agents, or lessee, spectators, and members of the
public in attendance at either activity contemplated hereby, or actually conducted by the
Applicant.
• The park is not responsible for any lost, stolen, or misplaced personal items.
NOTES: Applicant and its guests will comply with all rules and regulations established by the Winchester
Parks & Recreation Department. The Parks & Recreation Department reserves the right to dismiss any
persons from the facility. Applicant understands that Parks staff has the authority to determine if
participants are strictly adhering to all rules and regulations, and we have the full authority to enforce these
regulations. Parks staff must be respected and obeyed. NO foul language will be permitted.
PB&J Club Rental Application
Event Date: ___________________ Hours of Event: 5:30-8:00pm
Name of Person Requesting Use: _________________________________________________________
Mailing Address: ______________________________________________________________________
City: __________________________________ State: ____________ Zip Code: __________________
Day Phone: _________________ Evening Phone: _________________ Mobile Phone: ______________
Email: _______________________________________________________________________________
Child’s Name for the Party: ______________________________________________________________
Child’s T-shirt Size: □ 2T □ 3T □ 4T □ YS
Facilities Requested:
□ Recreation Room (20 occupant load-Room used with package rental)
□ Lord Fairfax Room (50 occupant load-Upgrade charge of $50.00)
Package Requested:
□ Package P-$100 □ Package B-$130 □ Package J-$200
Cleaning Charge
I understand I am responsible for my set up and clean up. If the facility is not left in satisfactory
condition, I will be charged time/materials to return facility into original condition. This fee must be paid
ten (10) business days after my reservation if I have left the facility in unsatisfactory condition. No future
reservation can be made until the fee is paid. ____ (initial)
I agree to pay additional fees if I have not vacated the premises by the reservation end time. ____ (initial)
Signature: ___________________________________________________ Date: __________________
Return form to: Stephanie Frazier, Winchester Parks & Recreation, Jim Barnettt Park, 1001 E. Cork
Street, Winchester, VA 22601
__________________
Application Date
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Completed 5 August 2020

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