Fillable Poolusepermit POOL USE PERMIT (Lake Havasu City)

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Poolusepermit POOL USE PERMIT (Lake Havasu City)

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U.S.A. forms for Lake Havasu City

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Pool Rental
City Use
Govt Agency
Private Commercial Non-Profit
Full Facility Rental Partial Pool Rental Lane Rental
Soaker Pool Soaker Pool/Whirl Pool Slide
Cost X = Estimated Number of Attendees
Birthday Party Rental
Upper Area OR Lower Area
Birthday Package is $83 and includes the following:
l Up to 20 swimmers; each additional swimmer will be regular price
l Two hours in one of our designated party areas
l Use of pool/slide/spray park
l Grill available upon request (user provide charcoal)
l Facility is capable of storing items requiring refrigeration
CA 1.11.18
Applicant:
POOL USE PERMIT
DATE RECEIVED:
Lake Havasu City Aquatic/Recreation Division
100 Park Avenue • Lake Havasu City, AZ 86403
Phone: (928) 453-8686 FAX : (928) 453-1133
Address:
Phone:
Cell:
Contact Name:
City, State, Zip:
Email:
Applicant's Signature:
Date:
Start/End Time:
Date(s) of Use:
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 the facility. Applicant agrees to be responsible for primary loss investigation,
defense, and judgement costs where this indemnification is applicable.
# of hours
Parents are welcome to come 15 minutes prior to start of the party to decorate. NO CONFETTI PERMITTED INSIDE
THE FACILITY. Food & beverages permitted in the facility with the exception of glass containers & alcohol. Refunds
require Director approval. All refunds are subject to a $15 administrative charge.
Description of Use:
Date:
FOR OFFICE USE ONLY
Total Due:
Cash/Check/Charge:
Receipt #:
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Poolusepermit POOL USE PERMIT (Lake Havasu City)

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Completed 23 January 2021

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