First & Last Name: ___
Organization (if applicable): _____
City: _____ Zip: _____
Street Address: ___
Email: _____
Phone: ___
Park/Facility Name: ___
Time In: _____ Time Out: _____
Date of Function: ___
Please Describe Function: ___
Number of Participants: ___
Percent Park District Residents: ___
Will you charge a fee? ☐ Yes ☐ No Will you hire a caterer? ☐ Yes ☐ No
Will alcoholic beverages be served? ☐ Yes ☐ No Will alcoholic beverages be sold? ☐ Yes ☐ No Please read page 2 for information on certificates of insurance and page 3 for our alcohol policy. Who will you secure insurance through? ☐ Personal ☐ Winnetka Park District ☐ Event Helper ☐ N/A Will you be setting up any temporary structures (e.g., inflatables, bounce houses, tents, etc.? ☐ Yes ☐ No Will you be hiring any entertainment? If yes, provide more information below. ☐ Yes ☐ No Please provide any additional information regarding your event: ___
Total Enclosed: $___ Type: ☐ Cash ☐ Check ☐ Credit Card ___ Exp Date ___
Cardholder's Name: ___ Authorized Signature: ___
Acknowledgment I have read, understand, and agree to abide by the Winnetka Park District facility rental procedures and regulations. I have read and fully understand the warning of risk, assumption of risk and waiver and release of all claims.
Name (please print): ___ Signature: ___ Date: ___
** REMINDER: Renter must pick up facility/park key one business day prior to rental at the Administrative Office.
OFFICE USE ONLY: Received By: ___ Date: ___
Rental Fee: $_____ Approved By: _____ Date: _____
Copy to: ___ Renter ___ Parks ___ Police
Security Deposit $ ___
COI Received: ___ Notes: ___