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ACTIVITY
APPLICATION FORM Name
of Group:_______________________________________________________ Address
of Group:______________________________________________________ City,
State, Zip:_______________________________________________________ Contact
person:_______________________________________________________ Local
Telephone:______________ Evening:_____________
Fax:_______________ Site
requested: __________ Baseball Fields _________
Soccer Field (check preference) Field 1 ______
Field 2 ______
Date
& Time Requested:__________________________
Activity, purpose,
description:_________________________________ A
non-refundable fee of $5.00 for field per day (practice), $5.00 per game will help to defray cost of
general maintenance. Please
be considerate of those who will be using the facility.
Vehicles must be parked in designated areas. Place all refuse in the appropriate containers.
I
understand the Township will hold the undersigned responsible for any property
damage, misconduct, or improper clean up resulting from the above named
activity. It
is understood and agreed that the Applicant assumes full responsibility for all
bodily injury and property damage arising out of the use of the premises
occupied by the Applicant or for the use of equipment owned by Penn Township. ______________ _____________________________ Date
Signature ___________________________________________________________________________ Date
Approved___________ Approved
by___________________________ Amount
Paid_________________ Paid By:
Check (
) Cash
Receipt No._______ |