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2. Name/Type of Event (Example: Birthday Party, Baby Shower, etc.)*
4. Location/Park*
6. Date of Event:*
7. Timefrome of Event (please include time for set up/clean up):*
9. Estimated Number of Participants*
10. Applicant/Organization Name:*
12. Email:*
13. Phone Number*
15. Person(s) in charge of event, if different from above:
17. General Information
19. Use of Tent:*

    1. Yes
    2. No
20. If yes, please provide sizing:
22. Bouncehouse:*

    1. Yes
    2. No
23. If yes, please provide sizing:
25. Sound Amplification:*

    1. Yes
    2. No
27. Merchandise/Food/Beverage Sales:*

    1. Yes
    2. No
29. Will port-o-potties be dropped off?*

    1. Yes
    2. No
31. Additional Event Information:
33. Upload Certificate of Insurance for Liability:
34. Upload Vendor Map with Vendor List:
36. Please check each section showing that you acknowledge and agree to the requirements.*

    1. Applicant is responsible for proper cleaning of park/area being used. This includes all decoration removal, clean up of trash around the area and proper disposal of trash is required before vacating the premises. If additional cleaning is required, the Town reserves the right to assess a cleaning fee of actual cost to the Town. Any additional charges incurred will be the responsibility of the Applicant and due the first business day following the event.
    2. Alcohol is not permitted in the parks unless a special event has been accepted and a liquor permit has been issued to the Applicant.
    3. Applicant shall be held responsible if any person within their party breaks or climbs upon, damage or deface the trees, shrubs, plants, turf or any of the buildings or other structures/property within or upon park premises, or in any way injure or impair the natural beaty or usefulness of any park or recreation area.
    4. Applicant is responsible for any and all accidents, injuries, damages or loss of property. The Town of Severance and its designated representatives shall be held harmless of any and all claims resulting from the use of the park.
    5. The Town of Severance logo may not be used on any promotional materials, advertisements, or communications related to your event. This is because your event is not sponsored or endorsed by the Town of Severance. Unauthorized use of the Town's logo or any other branding material may disqualify your event application or further actional as deemed necessary by the Town.
    6. Application must be received at least 10-business days prior to the event date. Reservations are not considered complete until official communication from the Town has approved the application. Applicants must be 18 years or older.
38. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    
    

    I acknowledge that the information contained in this application is true and complete to the best of my knowledge.

    1. I agree.
40. Electronic Signature*

42. YOU MUST INCLUDE A DIAGRAM/MAP OF BLOCKED AREAS IF THERE ARE ANY ROAD CLOSURES.

    **PLEASE CONTACT THE SEVERANCE POLICE DEPARTMENT WITH ANY ISSUES AT THE NON-EMERGENCY DISPATCH LINE 970-350-9600

44. Map of road closures/blocked areas
46. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    Release of Liability and Agreement to Hold Harmless

    All Park use by the applicant/sponsoring organization, its user group or its participants must adhere to Town policy and all applicable riles, regulations and usage restrictions set forth in the conduct and control of its user group or any other individuals participating under this permit, and further agrees to be financially responsible for all damage to the Park and any Town installations, appurtenances, structures, utilities or improvements on, under , or adjacent to the Park arising out of or resulting from applicant, its user group or its participants, including the cost of repair, restoration or replacement for such damage.

    
    

    The applicant/sponsoring organization hereby agree to indemnify, defend and hold harmless the Town of Severance, its officials and employees from and against all liability, claims and demands, to the extent caused by applicant/sponsoring organization or other individuals under its supervision or control, which arise out of or relate to all Park use by application/its user group or its participants under this permit.

    1. I agree.
48. Electronic Signature*
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field