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Application for Pavilion Rental Permits
**ALL FEES MUST BE PAID IN FULL AND CONTRACTS SIGNED BEFORE USE PERMIT WILL BE ISSUED FOR THE PAVILIONS

Name of Person Renting:   
Address of Person Renting:   
Home Phone #:  

Alternate #’s:  
E-M ail Address:  

Pavilion 1 Rental Fees:
Rental of the Pavilion at the top of the park with lights and 2 grills.
• Times Available for Rental: 8:00 a.m. – 10:00 p.m.
• $35.00 Deposit for each use. Please Check One:
• 4 Hours or “Partial Day”: $25.00  
• 8 Hours or “Full Day”: $55.00  
• Time of Rental Period: to Date:  

Betty Lloyd Pavilion Rental Fees:
Rental of the lower Pavilion; Includes access to bathrooms, horseshoe pit, and volleyball court.
• Times Available for Rental: 8:00 a.m. – 10:00 p.m.
• $50.00 Deposit for each use. Please Check One:
• 2 Hours: $30.00   
• 4 Hours: $60.00   
• 8 Hours: $120.00   
• Time of Rental Period: to Date:  

--------OFFICE USE ONLY--------


Pavilion Being Rented:     Waiver Signed:  

Date & Time:   
Deposit Paid:   

Total Amount Collected:    
Receiver of Application and Funds:  
_______________________________________________________________

Rules & Regulations for Rentals and usage of City Parks, Pavilions, Ball Fields

**Treat our Parks with Pride and ENJOY Them**


Park Rules
1. Use the park during park hours only or you will be ticketed by the City Police Department.
2. Do not drive or park on grass.
3. All pets must be on a leash.
4. Pick up and remove ALL trash after you are done with the park and place it in the trash cans provided.
5. No alcohol or drugs are allowed on the premises.
6. All applicable City ordinances must be observed at all times.

Rules for Use of the Pavilion & Ball Fields
1. The Pavilion and Ball Fields MUST BE RENTED AND PERMIT IN HAND in order to get first choice of use. (If someone doesn’t have a permit they may lose their spot.)
2. You must clean all trash from areas rented and place it in the trash cans provided.
3. You must clean any messes that are created during your rental time not limited to trash.
4. Return keys to City Hall if applicable.
5. No alcohol or drugs are allowed on the premises.
6. All applicable City ordinances must be observed at all times.

Rules for Rental
1. Bathrooms must be cleaned, toilets flushed, and trash set outside in the trash cans provided.
2. No alcohol or drugs are allowed on the premises.
3. All applicable City ordinances must be observed at all times.

**I agree to obey the rules of the Park and Rental or Use of Facilities.

Release & Waiver of Liability
The undersigned will sponsor, supervise, and/or organize an event program to be held at the
  (“Facility”) located in the City of Buckner, Missouri.

By signing this Release, the undersigned represents to the City of Buckner, Missouri (“City”) that on behalf of himself/herself and his/her organization: (i) the undersigned assumes all risks involved in all programs and activities, as well as in all other activities in which the undersigned may be involved during the course of its use of the Facility; and (ii) the undersigned signature is part of the consideration to the City for the undersigned to sponsor, supervise, or organize such program or activity at the Facility.

By signing this Release, the undersigned also releases and forever discharges and covenants not to sue the City, the Buckner Park Board, and their past, present, and future elected officials, officers, directors, insurers, agents, attorneys, employees, trustees, administrators, fiduciaries, and all other representatives (collectively, the “Released Group”) and agrees to indemnify, defend, and hold harmless the Released Group from and against all causes of action, judgments, interest, penalties, expenses, litigation costs (including reasonable attorneys’ fees, expert fees, and appellate fees and costs), and all other claims and demands of any kind whatsoever, including claims based on negligence, for bodily and personal injuries, including death, and damage to personal property, and the consequences thereof, arising at law or in equity, whether now liquidated or unliquidated, which the undersigned or any other third party may now have, has had from the beginning or time, or may have in the future, as a result of the events to occur during the course of the activity to be located at the Facility, and other events in which the undersigned may sponsor, supervise, or organize of his or her own free will at the Facility.

The undersigned hereby waives the benefit of any statute or rule of law which, if applied to this Release, would exclude from its binding effect any claim against any member of the Released Group not now known by the undersigned to exist. This Agreement is intended to be a general release and a covenant not to sue that extinguishes all claims and precludes any attempt by the undersigned to initiate any litigation against any member of the Released Group. If the undersigned commences any claim in violation of this Release, members of the Released Group shall be decided in accordance with Missouri law. This Release is binding on the undersigned and their respective heirs, legal representatives, successors, and assigns, in their own right, and in the rights of others.

I HAVE CAREFULLY READ THIS WAIVER OF LIABILITY AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I HEREBY AGREE TO BE BOUND BY THE TERMS OF THIS RELEASE.


Signature:  

Title:

Print Name:

Date: