Nikki Montembeault Washington Township Parks & Recreation Department 311 Production Drive Avon, IN 46123 317-745-0785 – Park Office www.washingtontwpparks.org Park Director SPECIAL EVENTS REQUEST FORM Special events include but are not limited to a performance, assembly, contest, exhibit, ceremony, parade, athletic competition, reading, concert, or other event requiring more space than that of a shelter or where the desire is to attract the general public to participate in an event using the Park property or facilities. Events in the Park cannot be political, impose upon the general public, offensive, discriminatory, or immoral in any way. The Washington Township Park has the right to accept, decline, and/or limit access for any event in the Park. Date of application:___________________________ Date of Event: _____________________________ CONTACT INFORMATION The Washington Township Parks Department should be contacted at least 60 days in advance of the proposed event. Additional forms/documents/permits/letters (see Page 6) not needing to be submitted at the same time as the Event Form must be submitted no later than 30 days before the proposed Event date. The User shall have a designated individual who is responsible for completion of the scheduling and application process for the event. Name/Group/Organization: __________________________________________________________________________ Name of Primary Contact:__________________________ Address:________________________________________ Email Address:__________________________________________________________________________________ Primary Phone Number:_____________________ Secondary Phone Number: _______________________________ Name of Event: ____________________________________________________________________________________ Type of Event: _____________________________________________________________________________________ (E.G. WALK/RUN, TOURNAMENT, FESTIVAL, CONCERT, FUNDRAISER, SHOW/EXHIBIT, CLASS) EVENT DETAILS Please attach a detailed copy of your agenda and/or any planned activities relating to the event. Description of event: ________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ Set up start time: _______________________ AM/PM Event start time: ____________________ AM/PM Event end time: ________________________ AM/PM Clean up end time:___________________ AM/PM Description of location: ______________________________________________________________________________ 1 _________________________________________________________________________________________________ Will you need access to any of our facilities? YES NO (E.G. PICNIC FACILITIES, VOLLEYBALL COUR, BASKETBALL COURT, PAVILION CENTER, ETC.) If so, please list the requested facility: _____________________________________________________________ __________________________________________________________________________________________ Will portable toilets be provided? YES NO If yes, who will supply them? _________________________________________________________________________ ATTENDANCE Users are required to provide a first aid station for events where the attendance is over 500 people. If the event is a youth function, one adult chaperone (over 21) is required for every ten youths under the age of 18. How many attendees are expected? ___________________________________________________________________ How many attendees expected under the age of 18? ______________________________________________________ Will you have volunteers working the event? YES NO Will there be live entertainment? YES NO How many?___________ If yes, what type? __________________________________________________________________________________ ADMISSION/GAMING If the event is a fundraiser, you must provide proof of the organizations 501 (c) 3 or non-profit status with this application and submit a signed letter from a 501 (c) 3 charity or non-profit acknowledging the fundraiser. If the user is hosting bingo, charity games, door prizes, raffles, sale of pull tabs or punchboards, you will need to determine if you are qualified to legally host these events. Refer to Indiana Code 4-32.2-4 at www.in.gov/legislative/ic/code/title4/ar32.2/ch4.html . Do you plan to charge admission onsite? YES NO Is the event open to the public? YES NO Do you plan to sell or give away merchandise? YES NO Circle any of the following that will be used in your event: BINGO RAFFLE CHARITY GAMES DOOR PRIZES DRAWINGS SALE OF PULL TABS / PUNCHBOARDS ADVERTISING Please provide a copy of all proposed promotional materials being used to advertise for the event as advertising must be approved prior to the publication and should be submitted for review with this application. A sign permit must be granted prior to posting any signs on Town property. The permit must be applied for at least three weeks prior to the date of the event. To obtain a permit application, visit www.avongov.org and under the section labeled “Government,” 2 click “Building Department” and click on the link labeled “Sign Permit Application.” Please attach any proposed advertisements and/or proposed signage designs along with the Event Form. Will the event be advertised? YES If yes, please circle how it will be advertised: Will signs be used? TV RADIO YES NO PRINT FLYERS EMAIL/LISTSERVS NO Please describe advertising efforts: ____________________________________________________________ __________________________________________________________________________________________ FOOD AND BEVERAGE An approved vendor permit must be obtained for each vender selling food, beverage, or merchandise on the park property. Food and beverage vendors must also supply the Washington Township Parks Department with a current copy of their Serv Safe certificate, Certificate of Liability Insurance, Health Department Certificate, Merchants Certificate, and alcohol license if appropriate. Will you be serving food or beverages? YES NO Please describe: ____________________________________________________________________________ __________________________________________________________________________________________ Will you be serving alcohol? YES NO Who will be providing alcohol? ________________________________________________________________ SECURITY/EMERGENCY SERVICES The Parks Department will review your event request and may require security present at your event. If your event does require security, you will be contacted to coordinate appropriate security arrangements. Other than the Hendricks County Sherriff’s Department, were you planning on bringing YES NO in outside security? If so, who? ________________________________________________________________________________ 3 TENTS/STAGES Any tents, stages, or stakes must be pre-approved and utility lines must be marked by the Indiana Underground Plant Protection Service prior to the tents or stakes being set up. It is the User’s responsibility to contact the Indiana Underground Plant Protection Service. They can be reached at the number 811. Will tents or other structures be used? YES NO Please describe: ____________________________________________________________________________ __________________________________________________________________________________________ Tent set up time:________________ Tent clean up time: _________________ Tent provided by: _________________________________ Will a stage be used? YES NO Please describe: ____________________________________________________________________________ __________________________________________________________________________________________ Stage set up time:________________ Stage clean up time: _______________ Stage provided by: ________________________________ Will sound amplifying equipment be used? YES NO Any other provisions pertaining to the event not addressed: ________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ ___________________________________________________________________________________ Special notes or requests: ____________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ ______________________________________________________________________________________ 4 THE USER AGREES AS FOLLOWS: 1. Not to make any additions or alterations to the premises without a written permission of Washington Township Park. This includes the drilling of holes into the ground or walls of the premises for the purpose affixing signs or banners. 2. Not to use or allow unlawful, improper, or offensive use of the premises, nor any use of the premises other than the proposed purpose stated above. 3. To conform to all of the rules established by the Washington Township Parks Department with respect to the premises. 4. To return the premises to its pre-rental/use condition. 5. The User shall not conduct or condone any illegal activities on the premises. The User understands that NO ILLEGAL DRUGS are permitted on the premises. 6. In consideration of this Agreement, the User agrees as follows: a. The User shall enjoy the right to exclusive use of the premises for the sole purpose of the purpose stated set forth above, subject to: i. The Washington Township Parks’ reasonable right of entry; ii. The User’s strict adherence to all terms in this Agreement; iii. The Washington Township Park’s right to terminate this Agreement and the User’s right of exclusive use of the premises at any time and for any reason. 7. The User is responsible for obtaining the necessary permits including but not limited to food and beverage permits, bonfire/burn permits, and charity/gaming licenses (see checklist for a complete list of the documents needed). 8. The User will be notified in a letter/email from the Washington Township Park when their special event request has been approved by the Parks Department and the Washington Township Trustee. 9. Washington Township requires a certificate of insurance for all special events held at the Park. Washington Township assumes no liability with respect to bodily injury, property damage, illness or any other damages or losses, or with respect to any claims arising out of any activity of the permit holder. 10. The Township will not be held responsible for damage to vehicles or loss of articles or merchandise left on the property. The User shall indemnify and hold harmless the Township from and against all damages, claims and liability arising from or connected with the renters event and /or use of the facility, including without limitation any damage or injury to person or property, the indemnification provided for shall include any legal costs and attorneys’ fees incurred in connection with any such claims, action, or proceedings. In the event of a renter’s breach of this agreement, resulting in the Township hiring an attorney, renter agrees that renter will pay the Township’s attorneys’ fees and costs, plus unpaid damages, fees and deposits owed, all accruing interest on any unpaid balance owed to the Township at the rate of 18% per year until paid in full. Each rental requires a designated individual to be responsible for completion of the scheduling and application process and who shall be responsible for the use of the Township’s property as set forth herein. The terms and conditions of this Agreement have been agreed to by: _______________________________ __________________________ ____________ _______________________________ __________________________ ____________ User Signature Park Director Signature User Printed Name Director Printed Name Date Date 5 _______________________________ Township Trustee Signature __________________________ Trustee Printed Name DOCUMENT CHECK LIST ____________ Date All completed forms/documents/permits/letters not needing to be submitted at the same time as the Event Form must be submitted to the Parks Department no later than 60 days before the proposed Event date. ITEM Event Form Pages 1-5 Map of Park Advertisements Certificate of Liability Insurance Charity/Gaming License Indiana Gaming Commission Fireworks (retail only) Avon Fire Territory Food and Beverages Hendricks County Health Department Governmental Documentation Parade or Public Gathering Washington Township Sherriff’s Department Nonprofit Documentation Signs Avon Building Department Tent/Other Structure Electrical Line Location INSTRUCTIONS DATE STATUS DATE COMPLETED Complete and sign page 5 Mark out area used during event and submit with the Event Form Submit proposed advertisement ideas for approval Submit with Event Form Request a letter from Parks to Commission Submit permit from Indiana Gaming Commission Submit permit/approval letter from Avon Fire Territory to the Parks Department Obtain Serv Safe certificate, Certificate of Liability Insurance, Health Department Certificate, Merchants Certificate, and alcohol license from each vendor Submit with Event Form Submit permit from Washington Township Sherriff’s Department to Parks Department for approval Submit with Event Form Submit approved permit to Parks Department Submit report provided by locator and time of contact to Parks Department All documents should be sent to… 311 PRODUCTION DRIVE AVON, IN 46123 ATTN: PARKS DEPARTMENT 6