and User Permit Form
of Organization/Individual (Permit Holder)
Purpose of Rental/Use: ___________________________________________________________________Special Requests: ____________________________________________________
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.
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 or Thurs-Sat ) or mailed to :