Application and User Permit Form


Name of Organization/Individual (Permit Holder)   __________________________________________________________________

Address ___________________________________________________________ 

City __________________      State _________       Zip _____________ 

Home Phone ____________________      Work Phone _____________________  

Fax ______________________     E-mail  _________________________ 

Date Requested __________________  

Time: From ___________ a.m./p.m. To ____________ a.m./p.m.

(Time is from time access is gained until cleanup is completed.  NO EVENTS ARE TO BE HELD AFTER 8 PM WITHOUT PRIOR WRITTEN APPROVAL)

Purpose of Rental/Use: ___________________________________________________________________

Special Requests:  ____________________________________________________

___________________________________________________________________

Anticipated Number of Guests Attending Event _________ The above named Permit Holder understands and agrees to comply with all the User Rules and Policies set forth by the Franklin Community Council, Inc.  The Permit Holder agrees that he/she is of legal age and is financially responsible for the repair of damage to equipment and/or facilities and for the replacement of missing equipment or furnishings related to above named event. 

Further, if the Franklin Community Council, Inc. has to bring suit to secure payment for any damages or missing equipment or furnishings, the Permit Holder and/or organization shall be responsible for all legal fees.  The Permit Holder and the above named individual/organization agree to hold the Franklin Community Council, Inc., harmless from, and all liability for, injury to persons or property as a result of your activities. 

By signing below, you agree to abide by all of the terms, policies, and applicable county and state statutes or regulations.

Applicant Signature _____________________­­­­­­­­____________________

Applicant Name (Printed) ____________________________Date ___________

Disclaimer:  FCCI shall have no liability for any claim, loss, damage, or expense incurred in connection with, or arising out of any injury or damage sustained by any person or property during or in connection with Permit Holder’s use of the Franklin Community Park. Permit Holder does hereby release, waive and forever discharge Franklin Community Council, Inc., its successors, assigns, members, directors, officers, employees, agents, attorneys and others acting on its behalf, from any and all claims, liability, actions, causes of action, demands, damages or suits, at law or in equity, of whatsoever kind or nature arising or resulting from or out of Permit Holder’s use of the Franklin Community Park facilities. Permit Holder does hereby further agree to indemnify and otherwise hold harmless Franklin Community Council, Inc., its successors, assigns, members, directors, officers, employees, agents, attorneys and others acting on its behalf, from the payment of any expense, including but not limited to attorney’s fees, which they or any of them incur, directly or indirectly, as a result of the subsequent assertion of any claim which is by these presents released and discharged or of any claim by any third person arising or resulting from, or out of Permit Holder’s use of the Franklin Community Park facilities.  

 Application Approved:  _________________________________________
                                                   (FCCI Representative)

Date Approved:   __________________________________

Sign and return this two page Application and User Permit form along with a copy of your drivers license (if dropped off at Community Center we can copy your driver’s license).    Upon approval you will receive a signed copy of the form which will be your permit.   Form may be dropped off at the community center during normal business hours

(Mon-Wed 10am-8pm or Thurs-Sat 10am-3pm) or mailed to :  

FCCI,   P. O. Box 43,  Franklin, Ks. 66735

Home
 Community Park
 E-mail: franklinkansas@yahoo.com