AGREEMENT TO BE FILLED OUT SIGNED AND LEFT AT CITY OFFICE I have read and agree to the terms and conditions listed in this Park Policy and Reservation Agreement (hereafter the "Agreement"). I understand that failure to abide by this Agreement may result in the loss of park privileges in the future. I understand that the City assumes no responsibility or liability for losses, claims, accidents, or injuries arising from my activity or my reservation at a park. Your Name: Your Organization: Address: City, State, Zip: Phone: Cell: Date of Birth: Drivers' License No: Reservation Date: Block: AM - PM: Time Opened - Closed. Park: Circle Park Facilities Needed: Kitchen - Restroom - Bowery - Basketball - Play Field - Other: Activity: Special Reservation: Entertainment - Fair - Market - Camping - Fire/fireworks - Sport - Other: Signature:. Date Office Use Only: Date Paid: Amount: Receipt No.: Received By: Special Reservations Mayor Approved: Yes or No Other: Park Policy and Agreement Page 5 of 5 ' 37