City Use Govt Agency Private Commercial Non-Profit
Estimated Number of Attendees Special Event Permit Issued
Please check all applicable areas of use for your event:
CA 3.2.17
DATE RECEIVED:
Applicant:
Address:
Lake Havasu City Aquatic/Recreation Division
100 Park Avenue • Lake Havasu City, AZ 86403
Phone: (928) 453-8686 FAX : (928) 453-1133
Event:
Applicant's Signature: Date:
Cash/Check/Charge:
Date:
Approved by:
Will your event include music?
Will your event include alcohol consumption?
City, State, Zip:
(Groups over 100 require Special Event Permit turned in at least 30 days prior to event)
YES
(No alcohol at Jack Hardie Park, no glass in all parks)
NO
NO
YES
Please note, we do not take reservations for volleyball or basketball courts at London Bridge Beach or bocce ball
courts or firepits at Rotary Community Park. Use of these facilities are on a first come, first served basis.
To the fullest extent permitted by law, Applicant agrees to indemnify, defend, save, and hold harmless Lake Havasu City, its departments, agencies,
boards, commissions, officers, officials, agents, volunteers, and employees (“Indemnitee”) for, from, and against any and all claims, actions, liabilities,
damages, costs, losses, or expenses (including, but not limited to, court costs, attorneys’ fees, and costs of claim processing, investigation and litigation)
to which any Indemnitee may become subject, under any theory of liability (“Claims”) to the extent that Claims are caused by the negligent acts,
recklessness, or intentional misconduct of the Applicant arising out of or as a result of use of a park. Applicant agrees to be responsible for primary loss
investigation, defense, and judgment costs where this indemnification is applicable.
Please give a brief description to any "Yes" answers above:
Will your event set-up equipment, i.e. air bounce, etc.?
Grass Area
(No water slides, bounce houses, or staking in grass)
Beach/SandVolleyball Court #Ramada(s) #
