Pavilion Rental Form

Rental Type *

Rental Date(s) *

Start Time

End Time

Organization Name *

Applicant Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Contact Numbers (Please include Cell Phone #, Home Phone # and/or Business Phone #) *

Borough Resident *

For Borough residents the rental fee is $50.00, non-residents $75.00

Event On-Site Contact Person *

First

Last

Contact Numbers (Please include Cell Phone #, Home Phone # and/or Business Phone #)

North York Borough Park Rules and Instructions acknowledgement *

I have read and understand this agreement and agree to abide by and be bound by the stated rules and regulations available for download on the North York Borough website. In addition, I agree to accept liability for all damages to the Borough's property occurring during the time rented, and I hereby release North York Borough and their heirs and affiliates from liability resulting from injury, accident or illness to myself or guests which may occur during this rental.

Signature and Date *