APPLICATION
RE: USE OF VILLAGE OF LAKEWOOD PARKS & FACILITIES
Individual or Organization:
Name: ___________________________________ Phone: ___________________
Address: _________________________________ E-mail: ___________________
_________________________________
______ Richard O. Hartley Park
______ Richard O. Hartley Park Gazebo
______ Community Park Pavilion
______ Veterans’ Memorial Park
TYPE OF EVENT OR ACTIVITY: ____________________________________________
DATE(S): ______________________________ TIME(S): _______________________
If the event is a class or instruction please provide the following information:
No. of participants: _____________________________________
Instructor(s): __________________________________________
_________________________________
Signature
APPLICATION APPROVED: ____________________________ Date: _____________
NOTE: Organizations using the parks and/or facilities are asked to provide a Certificate of Insurance
naming the Village of Lakewood as the Certificate Holder. Thank You.
