Application and Permit For Use of the Park Pavilion

VILLAGE OF BENTLEYVILLE
6253 Chagrin River Road, Chagrin Falls, Ohio 44022
Telephone: (440) 247-5055 Fax: (440) 247-3755
All reservations must be made two weeks prior to the date of the event.
(Must be 21 years old and provide photo identification)

Park Pavilion Permit Application

* Name

* Email Address

Date of Birth MM/DD/YR

* Street Address

* CIty

* State

* Zip Code

* Contact Phone

Business Phone

Name of Organization

* DATE(S) DESIRED

EVENT OR ACTIVITY HOURS AND DETAILS

* Event Start Time

* Event ending time

* Number Expected

* Person in charge of Event

Check the following items if needed:

Water Pump

Electricity

Submission date & time

Date:

Time:

I hereby agree to hold myself responsible for the supervision of the event, for the conduct of all persons present, and for any damage which may result to property. I agree to be responsible for all charges that may be made and release the Village of Bentleyville from any liability for use of the park pavillion. I have read and concur with the conditions as outlined below.

* Signature

*A two hundred dollar security deposit is required to complete the filing of this application. The security deposit shall be returned within ten days provided the park pavillion is left in a clean and orderly condition and no damage has occurred at the park pavilion. If the park pavilion is not cleaned or is damaged in any manner, the security deposit shall be forfeited.

*Must notify Chief of Police within 72 hours if the event is cancelled, otherwise, the security deposit is forfeited.

Permit approved

Permit not approved

Chief of Police

Contact the Village Admin for additional information.

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