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Picnic Shelter Permit Application Form

  1. CoE Logo Square Oct 2018

  2. Picnic Shelter Permit

    If someone is not honoring this permit, please call Kittcom (509) 925-8534

  3. In four hour blocks of time, list your start time (e.g. 12-4 PM, list 12 PM as your start time)

  4. Declaration

    I am fully aware certain danger and risks are inherent in activities offered by the City of Ellensburg Parks and Recreation Department. In consideration of being allowed to participate in these activities and/or use of a City facility, I hereby assume all risk of physical injury, death, damage and liability arising from such activities or use and hereby release the City of Ellensburg, its officials, employees, and agents, and waive any right of recovery I might have to bring a claim or lawsuit against them, for personal injury, death, damages or liability arising out of my voluntary participation in such activities and/or use of City facilities. I understand that the renter accepts full responsibility for facility cleanup and any damage to facility or equipment caused by any persons during the duration of this rental agreement. I also hereby certify that I am a responsible representative, 18 years of age or older, and I have read and agree to the rules and regulations.

  5. By typing my name, I declare all information is correct, and this printed name serves as my signature.

  6. Acknowledgement*

    Please check each bullet point acknowledging that you have read and agree to each item.

  7. STAFF USE ONLY

  8. Leave This Blank:

  9. This field is not part of the form submission.