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Athletic Field Reservation Application | Page 1 of 5
INSTRUCTIONS
Please review the City of Burlington’s Field Use Policies for detailed information regarding reservations and submittal
deadlines.
Questions may be directed to (360) 755-9649 or BParks@burlingtonwa.gov.
Complete pages 1-4 of the following application form and return to Burlington Parks & Recreation to request field
reservations. Mail/Deliver to: 900 E. Fairhaven Avenue or Email to: BParks@burlingtonwa.gov
Burlington, WA 98233
Please be aware that no legal or binding commitment exists between parties until a Field Use Permit has been issued.
APPLICANT INFORMATION
Name of Sponsoring Organization or Individual:
Classification: Non-Profit, ID# Private Citizen or Group For-Profit/Commercial
Organization Website Address:
Billing Address:
City/ST/ZIP:
AUTHORIZED REPRESENTATIVE INFORMATION
Name of Primary Contact Person: Position:
Phone: Email:
Billing Contact Person: Same as Above or, Name:
Phone:
Email:
GENERAL ACTIVITY INFORMATION (Complete ALL that apply)
Activity Title: Sport Type:
Field Use Type: Game(s) Turnout/Practice Camp/Clinic One-time/Incidental Use
Activity Start Date: End Date:
Target Age Range(s):
Target Audience: Men/Boys Women/Girls Co-Ed Other:
# of Participating Teams: Average # of Players per Team:
SPECIAL REQUESTS (Complete ALL that apply)
Painted Field Lines Parks Staff Assistance is Needed
Merchandise Sales
Food Sales
Use of Skagit River Park Concession Room
Use of Amplified Sound Describe:
Use of Scoreboards (Baseball)
Access to City Utilities: Potable Water Electricity Purpose:
Other Requests:
ATHLETIC FIELD RESERVATION APPLICATION
Leagues, Camps/Clinics, Single/Incidental Use
Athletic Field Reservation Application | Page 2 of 5
FIELD RESERVATION REQUESTS
Turnouts/Practices ONLY
Baseball/Softball Base Path Needed & Quantity of Each: 55’ # 60’ # 90’ # Other:
Location(s) Requested: Skagit River Park Rotary Park
Grass Field Micro (up to 20yds x 30yds) Total Quantity:
Standard (up to 75yds x 120yds) Total Quantity:
Other, Describe:
Location(s) Requested: Dike District Fields Rotary Park
Jack Doyle Park Whitmarsh Fields
Reservation Dates Requested:
Base Path Length
or Grass Field Dimensions
Day of Week
Start Date
End Date
Start Time
End Time
M Tu W Th F Sa Su
M Tu W Th F Sa Su
M Tu W Th F Sa Su
M Tu W Th F Sa Su
Describe Equipment you wish to setup for your activity:
Additional Comments or Requests:
Total Hours Requested for Practices/Turnouts:
FIELD RESERVATION REQUESTS
Games, Camps/Clinics, Single/Incidental Use ONLY
Baseball/Softball Base Path Needed & Quantity of Each: 55’ # 60’ # 90’ # Other:
Location Requested: Skagit River Park Rotary Park
Grass Field Micro (up to 20yds x 30yds) Total Quantity:
Standard (up to 75yds x 120yds) Total Quantity:
Other, Describe:
Location(s) Requested: Skagit River Park Dike District Fields Rotary Park
Not available for Games: Jack Doyle Park Whitmarsh Fields
Reservation Dates Requested:
Base Path Length
or Grass Field Dimensions
Day of Week
Start Date
End Date
Start Time
End Time
M Tu W Th F Sa Su
M Tu W Th F Sa Su
M Tu W Th F Sa Su
M Tu W Th F Sa Su
Describe Equipment you wish to setup for your activity:
Additional Comments or Requests:
Total Hours Requested for Games, Camps/Clinics or Incidental Use:
Athletic Field Reservation Application | Page 3 of 5
Initials & Signature of the Applicant / Applicant’s Authorized Representative is required in the Acknowledgment and
the Hold Harmless & Indemnification sections below indicating understanding of the statements and intent to comply.
ACKNOWLEDGMENTS
Minimum Age. I certify that I am 18 years of age or older and am an authorized representative of Applicant.
Application Timeline. I understand that I may expect receipt acknowledgment from Burlington Parks & Recreation
within 10 business days of my application submittal.
Insurance. The City of Burlington does not maintain insurance that will respond to claims against me, the Applicant,
arising from my use, my affiliated members/participants’ use or use by those attending my activity. When required by
the City, I will provide written documentation meeting the minimum requirements outlined in the City’s Athletic Field
Use and Reservation Policy as proof of my general liability insurance coverage. (Sample information can be found on
pages 5-6 of this document.)
Field Use & Park Rules. I, the Applicant, or an individual authorized to act on the Applicant’s behalf, have read,
understand and agree to abide by all field use policies and park rules described in the City’s Athletic field Use &
Reservation Policy.
Alcohol & Marijuana. Washington State law prohibits the consumption or use of alcohol or marijuana products in any
form in public places, which includes all City of Burlington outdoor park facilities. It also prohibits the opening of
packages containing alcohol or marijuana products in any form. Please refer to the Revised Code of Washington
(RCW) sections 66.44.100 and 69.50.445 for detail. A person who violates these sections is guilty of a class 3 civil
infraction under chapter 7.80 of the RCW.
Standard of Behavior. I, the Applicant, understand that I, my affiliated members/participants and those in attendance
of my activity are expected to obey all laws governing the City of Burlington and the State of Washington and to
behave in a respectful manner during our use of the playfields. Fighting, abusive or threatening language, public
urination, intoxication and littering are examples of behaviors that are considered unacceptable. I understand it is my
responsibility to address unacceptable behavior if it occurs. The City of Burlington may at its discretion terminate my
Field Use Permit if unacceptable behavior concerns persist.
Field Prep & Cleanup. Equipment I wish to setup to support my activity must be preapproved, in writing, by the City.
I understand that I am responsible for leaving my designated playfield area free of debris and garbage upon my
activity’s conclusion. I will place garbage created by my activity in the waste dumpster provided onsite or I will haul it
off-site. I also understand that I will be responsible for payment of a cleanup fee when the City deems my post-
activity cleanup inadequate.
Cancellations & Changes. I understand that once my application is approved, the Cancellation & Refund Policy
described in the City’s Athletic Field Use & Reservation Policy applies. My written confirmation must be received by
the City in order for my cancellation or change to be considered binding.
Departmental Access. I understand that Burlington Parks & Recreation and the City’s authorized representatives
shall have free access to the premises at all times.
Private Vehicles. My personal vehicles and those of my affiliated participants and guests are not permitted on the
playfields at any time unless prior written approval has been granted from the City.
Playfield Conditions. I understand that my playfield reservations may be cancelled at the City’s discretion when it
has determined imminent conditions exist that could potentially cause damage to the playfields or put field users’
safety at risk. Should this occasion occur, I can expect the City to notify me with as much advance notice as is
feasibly diligent.
(Please INITIAL Below)
Athletic Field Reservation Application | Page 4 of 5
HOLD HARMLESS & INDEMNIFICATION AGREEMENT
With my signature below, I, the Applicant or Authorized Representative of the Applicant, hereby request of the City of
Burlington the use of City facilities as described herein and certify that the information in this request is correct and complete.
I agree that no persons will be excluded from participation in, or denied the benefit of, or otherwise subjected to discrimination
because of the person’s race, color, national origin, age, handicap or other protected class status during my use of the City’s
facilities. I further agree to exercise the utmost care in my use of the City's facilities and agree to reimburse the City for any
costs incurred by the City in repairing damage to its facilities caused by my activity.
I agree to defend, indemnify and hold harmless the City of Burlington, its Elected Officials, Appointed Officers, Employees and
Agents from all liability resulting from my use of City facilities except only such liability as shall have been occasioned by the
sole negligence of the City of Burlington. I agree to observe and comply with all provisions of laws and ordinances governing
the City of Burlington and the State of Washington.
Printed Name of Applicant or Authorized Representative:
Signature:
Date:
PAYMENT SCHEDULE
League Games,
Turnouts/Practices: Payment of 50% of field rental fees is due when final field allocation has been approved.
Payment of the remaining balance along with payment of all miscellaneous fees associated
with the activity (i.e. portable restrooms, field lining charges, lining paint…) is due upon the activity’s
conclusion within 30-days of billing.
Camps/Clinics,
One-Time/Incidental Use: Payment is due in full at time of field reservation confirmation.
FOR CITY USE:
Date Application received by City: By:
Field Allocation APPROVED AS REQUESTED. Permit Attached.
Field Allocation APPROVED WITH CHANGES. Permit Attached with Detail.
Field Use NOT APPROVED. No Permit Issued. Remarks:
Staff Signature: Date:
Title:
PAYMENT RECEIPT INFORMATION
Date Received
Amount Received
Form of Payment
Receipt #
Initial Payment:
Final Payment:
Athletic Field Reservation Application | Page 5 of 5
INSURANCE REQUIREMENTS
The City must receive a valid Certificate of Insurance accompanied by the policy’s Endorsement at least 30-days prior to your activity’s start date. Please ask
your insurer to forward the documents containing the minimum requirements listed below. The documentation should be emailed to BParks@burlingtonwa.gov.
Certificate of Insurance
Certificate Holder must be listed as “City of Burlington”
833 S. Spruce Street
Burlington WA 98233
Minimum thresholds of coverage: $2,000,000 General Aggregate
$1,000,000 per occurrence
Certificate must include the remark “Additional Insureds include the
City of Burlington, its elected officials, officers, employees & agents.”
Endorsement
An Endorsement using ISO Form CG 20 26 or coverage at least as
broad must accompany the Certificate of Insurance.
Additional Insured must be listed as “City of Burlington”
833 S. Spruce Street
Burlington WA 98233
The Endorsementmust reference the Insured’s policy number.
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Completed 17 January 2021

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