CITY OF KINGSBURG
PLEASE INDICATE WHICH PARK APPLICANT IS APPLYING FOR –SEE REVERSE FOR MAP AND USE POLICIES
________Memorial Park (Sierra & 18
th
St.) ________Downtown Park (Marion & Lewis St.)
P
ARK APPLICATION AND USE PERMIT
DATE OF RESERVATION ___________________________ TODAY’S DATE____________________
APPLICANT INFORMATION (Applicant must be 18 years or older)
Name of Applicant or Organization: ____________________________________________________________
Address: ________________________________ City: _________________________ Zip Code: ___________
Telephone (Home #) __________________________ Business#: ___________________________________
FACILITY INFORMATION
FACILITY AREA: ____________________________________________________________________________
Time- From: _______ To: ______ Reason for Rental: ______________________________________
N
UMBER OF PEOPLE WILL THERE BE LIVE MUSIC? YES / NO
PLEASE CIRCLE THE FOLLOWING
Electricity: YES / NO Bounce House: YES / NO
If you have a Bounce House, please list the company: ______________________________________________
KINGSBURG POLICE DEPARTMENT WILL BE
NOTIFIED OF ALL PARK PERMITS. PARKING
ON THE GRASS IS NOT PERMITTED. USE
AND CONSUMPTION OF ALCOHOLIC
BEVERAGES IS PROHIBITED DO NOT MOVE
PARK BENCHES OR TABLES FROM
ASSIGNED AREAS
*IF YOU NEED ASSISTANCE DURING YOUR
RESERVATION, CALL KPD (559)897-2931*
FEES - FOR OFFICE USE ONLY
Facility Rental Fee ………. $
Electricity Fee ………… $
Total Due ………………...$ ____________
Insurance Required YES / NO
Special Events Permit Required YES / NO
The
undersigned agrees to indemnify, defend (with legal counsel acceptable to the City of Kingsburg) and hold harmless the City of
Kingsburg and its officials, agents, employees and officers against any and all liability, losses, claims, damages, fees of attorneys, and
other expenses which the City or its agents, employees or officers may sustain or incur in consequences of the use by the undersigned
or its invitees or arising out of any act or activity conducted by the undersigned on facilities owned by the City, including but not
limited to, sums paid or incurred in connection with claims, suits, or judgment or paid or incurred in attempting to procure release
from liability for any person injured as a result of the activities herein referred to.
Applicant agrees to comply with and abide by all of the provisions of this Application and Use Permit.
Applicant has received a copy of and has read the City of Kingsburg’s facility rules and regulations and agrees to comply with and
abide by them and cause all persons present at the facilities to abide by and comply with them.
I hereby certify that all the information provided above is correct.
APPLICANT’S SIGNATURE DATE
FEES PAID__________ DATE PAID__________ DATE EMAILED ____________
PERMIT ISSUED BY____________ _____________ DATE SPECIAL EVENT PERMIT COMPLETED
SEE REVERSE FOR MAP AND FACILITY USE POLICIES
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