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Indian River County Parks Division <br />Pavilion Reservation Application <br />550077 th Street • Vero Beach, FI 32967 <br />Phone (772) 589-9223 www.ircgov.com/parks <br />Date of application: <br />I hereby request the reservation permit for the following <br />pavilion(s): <br />❑ Kiwanis Hobart Park Pavilion 1: <br />$75 + tax <br />❑ <br />Dale Wimbrow Pavilion: <br />$25 + tax <br />❑ Kiwanis Hobart Park Pavilion 2: <br />$65 + tax <br />❑ <br />Gifford Park Large Pavilion: <br />permit required <br />❑ Round Island Riverside: <br />$25 + tax <br />❑ <br />West Wabasso Pavilion 1: <br />permit required <br />❑ South County Large Pavilion: <br />$65 + tax <br />❑ <br />West Wabasso Pavilion 2: <br />permit required <br />❑ South County Small Pavilion: <br />$25 + tax <br />❑ <br />Special Event: <br />$100 + tax <br />*If you are tax exempt you must supply a copy of your Florida Consumers Certificate of Exemption" <br />Requested date(s): <br />Requested time (include set-up & clean-up): <br />Name of applicant: <br />Address: <br />Phone number: <br />Please check any that apply to your event: <br />Amplified sound <br />Water slide <br />Other (please describe): <br />Type of event: <br />Expected number of people: <br />Email: <br />Bounce House (requires insurance) <br />Tents (see note below) <br />Any tents used that are larger than 10x10 will require a Special Events & Tents Sales permit from the Indian River County Fire & Life <br />Safety Bureau which we can supply to you. Fees will apply. (www.ieces.cbm/Fire_Division/Documents/Spetial_Event Permit..pdf) <br />Your signature acknowledges that you have read and understand the attached rules and regulations. Further, the applicant certifies <br />that he/she is authorized to obligate the organization or group he/she is making this request the ensuring compliance with these <br />rules. The applicant hereby agrees to protect, indemnify, defend, save and hold harmless Indian River County, Florida from all claims, <br />demands, liabilities, any suits of any nature whatsoever arising out of, because of, or due to this license, or due to any act or <br />occurrence of mission or commission of the applicant, its agents or employees. <br />X <br />Applicant <br />PAYMENT METHOD: CASH <br />Office staff only <br />CHECK CARD <br />Date <br />APPROVAL: <br />Agreement for the use of a pavilion in a county park has been approved, subject to the conditions stated herein: <br />Date: <br />Authorized Parks Division Representative <br />P100 <br />