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Summer BBQ & Movie Night

June 2nd, 2017 Timnath Community Park

ATTENTION: BEFORE COMPLETING THIS APPLICATION, YOU WILL NEED ALL OF THE DOCUMENTS LISTED BELOW. THESE DOCUMENTS NEED TO BE SAVED ON YOUR COMPUTER AND AVAILABLE TO UPLOAD WITH THIS APPLICATION.

Any information you enter on this application will not be saved if you begin and return later.

* indicates required field
1. Copy of Driver's License*
2. SIGNED & DATED Permit Agreement and Waiver*
A copy of this form can be obtained at the link below:
* Permit Agreement & Waiver (Upload your signed copy of this document in the section above.)
For your reference, click here to read the Pavilion Rental Policy.
Name(s) of Permit Holder*
First Last
Additional Permit Holder
First Last
Phone*
Email*
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Driver's License Number and State Issued:*
Type of event*
Date of event*
Event Start Time*

: HH

MM
Event End Time*

: HH

MM
How would you like to receive your permit?*
- Email to the address above
- Mail to the address above
- Pick up in person at Timnath Administration building (4800 Goodman St.)
FEES:
$40 non-refundable
$50 Cleanup/Damage Deposit (refundable)
I declare, under penalty of perjury, that the statements made herein are made in good faith, and are true, correct, and complete, to the best of my knowledge.
Signature of Permit Holder*
First Last
Date*
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