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Wednesday, July 23, 2008
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South Kingstown Parks and Recreation 325 Columbia Street, Peace Dale, Rhode Island 02883 (401) 789-9301 * (401) 792-9617 (fax) www.southkingstownri.com/parksrec |
| Organization (if applicable): | ||
| Contact Person: | Phone: | Fax: |
| Email: | ||
| Address: | Town: | Zip: |
| Time requested must include preparation and cleanup. Facility request not approved until you receive confirmation from the Parks and Recreation Department. | ||
| Event: | Num of Participants: | |
| Date(s): | Starting Time: | Ending Time: |
| Requested Facility(s) | ||
| ____ Brousseau Park | ____ Town Beach | ____ Town Farm |
| ____ Tuckertown Park | ____ Curtis Corner Playfields | ____ Neighborhood Guild |
| ____ Old Mountain Field * | ____ West Kingston Park * | ____ Broad Rock Playfields * |
| ____ Green Hill | ____ Nature Center | |
| _____ *Lights will be needed at the facility I am requesting | ||
| Area(s) Requested | ||
| ____ Baseball Field | ____ Softball Field | ____ Picnic Area |
| ____ Volleyball Court | ____ Soccer Field | ____ Guild Meeting Room ** |
| ____ Tennis Court: | ||
| ** Please describe Guild room set-up: | ||
| Participation Waiver | ||
| In consideration of the use of a South Kingstown recreation facility, I hereby waive, release, and discharge any and all claims for damages, death, personal injury, or property damage which I may have, or which hereafter accrue to me as a result of my use of the facility. This release is intended to discharge in advance the Town of South Kingstown, the Town Council, the South Kingstown Recreation Commission, its officers, agents and employees from and against any and all liability arising out of or connected with the use of said facility. It is understood by my signature below that I have agreed that this waiver, release and assumption of risk is to be binding on my heirs, personal representatives, next of kin, spouse, and assigns. | |
| The signature below indicates the requesting group or individual is in agreement with all South Kingstown Parks and Recreation facility use procedures (see Facility Use Procedures) and the participation waiver. | |
| Signature: | Date: |