HAMPDEN TOWNSHIP

FACILITY RESERVATION APPLICATION 

(For Hampden Swimming Pool)

                                                                                                     Today’s Date_____________

All groups or persons requesting use of facilities must provide the name and telephone number of a local contact person who will assume responsibility for administration of the activity and be available during the scheduled activity.

Name/Group Name___________________________________________________________________

 Address_____________________________________________________________________________

 Local Contact  _______________________________Phone:  Day___________ Evening____________

 FACILITIES REQUESTED: (Please circle)

   Main Pool        Sprayground      Wading Pool      Diving Well         Lap Lanes      Learn To Swim     Entire complex

 Date(s) and Time(s) Requested (Please be specific and include time required for set-up and clean-up) ________________________________________________________________________________________________

________________________________________________________________________________________________

Describe the activity in detail (Attach a letter if necessary)_________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________________

 Will an admission fee be charged ?             No             Yes             Amount_____________

Will participants be charged a registration or entry fee ?        No             Yes             Amount__________

Number of spectators ?__________  Number of participants?_______________

Will this activity generate revenue?          No             Yes                                                                      

Does this activity include plans for concessions, vendors, rented equipment, or caterers?             No        Yes*

*(If yes, please give details below, prior approval is necessary)

________________________________________________________________________________________________

________________________________________________________________________________________________

 Does this activity require any special services or equipment? (Fees may be charged for use of some equipment and services)

 Pool Lights - Yes             No             Maintenance assistance- Yes      No

 Ambulance service – Yes     No (If yes, please contact EMS Coordinator - 761-5343)

 Other - ________________________________________________________________________

 I/We have read the guidelines regarding use of Township Facilities and agree to assume responsibility for observance of these regulations.  I/We shall agree to assume all responsibility for any damages incurred beyond normal wear and tear and I/we also assume all liability for personal damages or injuries incurred through use of the facility and relieve Hampden Township and its officials of any responsibilities for such activities.  I/We understand that a portion of the rental fee may be non-refundable and may not be returned in case of cancellation, property damage, or the requirement of more than customary cleaning. 

 SIGNATURE OF CONTACT PERSON                                                                          Date                            .

 Please Return Reservation Request and Reservation Fee, if required, to:

Hampden Township Recreation Department

 Payment  By:  Mastercard/Visa #                                                                  EXP date_____________

Signature of card holder                                                                                                           

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