Responsibility of Applicant/
General Rules for Alcoholic Beverage Consumption

1. No alcoholic beverages may be consumed from glass containers.
2. Alcoholic beverages may only be consumed from within 50 foot radium of the park pavilion
3. No alcoholic beverages may be dispensed from a temporary bar or keg type apparatus without permission from the Village Administrator or his designee.
4. It will be the responsibility of the applicant to make sure that all rules are followed, and that cleanup is complete at the end of the use of the pavilion.
5. Ejection: Any authorized village official and/or state, county or local peace officer shall, in connection with their duties, have authority to eject from the park land and any person acting in violation of these rules.

Being an adult over the age of 21, I have read and understand the regulations governing alcoholic beverage consumption in Hickory Park and the park pavilion listed above under Responsibilities of Applicant / Gneeral Rules For Alcoholic Beverage Consumption. I will be at the pavilion and supervising my group for the entire time the pavilion park is used by me or my group. I assume responsibility for my or my group's use of the pavilion and park on the date approved as detailed on this application. I understand that by the village issuing this permit, , I, as an applicant assume full responsibility for consumption control. The Village of Bergen assumes no consequential liability whatsoever as a result of issuin this permit.

Signed________________________________________________________ Dated ______________________

I, Village Administrator for the Village of Bergen, grant this group permission to consume alcoholic beverages at Hickory Park between the hours of _______________ and _______________ on the dates listed below.

Signed __________________________________________________________ Dated ____________________
- - - - - - - - - - - - - - - - - - - -Administrator/Clerk-Treasurer - - - - - - - - - - - - - - - - - - - - -