Date of Event / Time of Day
Applicant/Resident Name
Address
City, State, Zip
Telephone 1 / Telephone 2
Driver’s License Number / # of people expected

The undersigned hereby makes application for the use of the above described facilities and agrees to abide by the rules and regulations in effect, to leave the facilities in good condition, and report any damage done during the use of the facilities to the Greene Township Department office within 24 hours of departure. The applicant agrees to hold the Township free and harmless from any liability of any nature.

I certify that I have received a copy of the condition of use policy and general rules for usage and I understand and agree to abide by them. I further understand that any expenses to repair the facilities at the Mill Creek Community Park may result in the withholding of the security deposit and future permits.

I understand that the rental fee is $50 per day and that $25 of my $50 deposit for each day reserved will be returned upon the satisfactory inspection of the pavilion area.

Signature of Applicant / Date of Application

For Township Only

Status of Application

Approved Denied Confirmed date is available

Added to Calendar

Deposit Received ______

Refund

$25 refund returned by _____ cash / _____ check #______

Deposit withheld due to damages described below and evidenced by invoices for repairs.

Inspection conducted by ______on ______

/ PAVILION RENTAL RULES & Conditions of Use
  • Pavilion must be reserved through the Greene Township Office located at 262 Pittsburgh Grade Rd., Hookstown, PA 15050. 724.573.1111
  • Reservation must be made by a Township resident, one that lives within the confines of Greene Township and must pay a $50 deposit, $25 of which will be refunded upon a satisfactory clean-up inspection by a Township employee.
  • Clean up must be complete within 24 hours of use, or the entire amount of the deposit will be forfeited.
  • Damages will be assessed and deducted from the deposit. In the event that damages are in excess of the deposit, the deposit will be forfeited. Additional charges will be the responsibility of the reserving party.
  • The Greene Township resident reserving the facility is responsible for any and all damages.
  • The pavilion may be reserved for any day, from dusk to dawn.
  • No alcoholic beverages are permitted in the Mill Creek Community Park premises.
  • Potential users should be aware that there is no water supply, and restrooms are composting type units. Posted restroom rules for paper disposal must be observed.
  • The “Pavilion Reserved” sign, provided by the Township to the reserving party, must be posted on the pavilion in plain view on the reservation date.
Insert name of family or event here

Date of Event ______Time of Event ______

______

Authorized by Greene Township Secretary

S:\DOC\PARKS\PAVILION RENTAL APPLICATION.docx