CONTACT PERSON/RESPONSIBILITY PARTY

Name(s) ______________________________________
_____________________________________________

Organization __________________________________

Address ______________________________________

City _________________________________________

State ___________________________ Zip___________

Phone # _______________________________________

Town/Village Resident - YES / NO

PARK RESERVATION

Date __________________________________________

Time __________________________________________

Event _________________________________________

____ Need Alcohol Permit? (No fee)

____ Need Port-a-Potty? ($20 fee)

____ Need Electricity? ($10 fee)

Other Special Requests ____________________________
______________________________________________
______________________________________________

KEY DEPOSIT

____ Deposit Paid? ($5 refundable deposit)

____ Keys & Deposit Returned?

Signature ______________________________________

ACCOMMODATIONS

1. Water Fountain Available
2. Public Restrooms available (although toilet paper is provided, you may want to bring your own to be sure.)
3. Electric available upon request

For special accommodations, and large group events, please see Village Administrator.

THE VILLAGE RESERVES THE RIGHT TO CHARGE APPROPRIATE FEES IF ADDITIONAL SERVICES ARE REQUESTED, REQUIRED, OR DEEMED APPROPRIATE IN THE VILLAGE'S DISCRETION. (Ex. Clean-up, security, etc.)

FEES

There is no fee to use or reserve the park pavilion.

There is a $10 fee for electric service.

There is a $20 fee for Port-A-Potty rental if you request one. (Public restroom is available.)

RULES -------------------- Park Hours: 7am - 9pm

-- Garbage must be taken with you when you leave or left near receptables in Village of Bergen bags ($2.00 each).
-- Keys must be picked up at Village Office or DPW during normal business hours (M - F, 8 - 5pm).
-- You are responsible to lock up when you leave. (keys to gate on Parkview Drive and bathroom). Parking in lot on Lake Street only. NO parking in park or by Pavilion. Drop off supplies only from Parkview entrance.
--Alcohol Beverages by permit only.
--No glass containers
--Pets permitted - Pick up after your pet.
--Damage will be prosecuted to full extent of law.
--Violation of rules is cause for eviction.