First Last
Name of Group/Organization: _________________________________________________________
Contact Person: __________________________________ ________________________________
Mailing Address: ________________________________________ _________ _____________
Street State Zip Code
Daytime Telephone: _(____)______-_______ Evening Telephone: _(____)______-_______
Cell Phone: _(____)______-_______ Facsimile: _(____)______-_______
Email address: __________________________________________
Check One: New Park Partner Park Partner Renewal
Term of Prior Agreement: From: ____/____ To: ____/____
MO / YR MO / YR
Name/Location of Park Interested In: _________________________________________________________
Entire Park Specific Area:___________________________________________________________
Frequency of Maintenance to be Performed by Park Partner: Weekly Monthly Quarterly
Great American Clean Up (1
st
Saturday in April) Pride Day (2
nd
Saturday in October)
Other: ________________________________________________________________________________
Proposed: Type of Free Community Events To Host/Requested Dates:
1. Description: ______________________________________ Date: ____/_____/______
2. Description: ______________________________________ Date: ____/_____/______
3. Description: ______________________________________ Date: ____/_____/______
4. Description: ______________________________________ Date: ____/_____/______
Proposed: Type of Fundraising Event Requested (one allowed per year) and Proposed Date:
Description: ______________________________________ Date: ____/_____/______
Estimate of Funds to Be Raised:
$_______________________
Proposed: Donations to be Funded by Park Partner: Trees Benches, Tables, Waste Receptacles
Other Amenity (describe): ___________________________________________________________
I HEREBY certify that I am authorized to act on behalf of the group/organization listed on this application:
_____________________________________________________ _____________________________
Signature Date
Revised 12/01/2011
PLEASE DO NOT WRITE IN THIS AREA.
PARKS AND RECREATION STAFF USE ONLY
Date Received by PARD ______/_______/______
Initial: ________