Park Use Permit

Exactly as extracted, unformatted — for checking against the original. The readable version is easier to read.

THE TOWN OF CENTREVILLE 101 LAWYERS ROW CENTREVILLE, MD 21617
410-758-1180 FAX 410-758-4741 WWW.TOWNOFCENTREVILLE.ORG
PARK USE AGREEMENT
 Millstream Park Pavilion  Centreville Wharf Park
 Picnic Tables  Picnic Tables
 Pavilion Lighting  North Pocket Park
 Water  South Pocket Park
 Other  Pop Taylor Pocket Park
Name of Organization
Contact Person
Address
Phone Number Cell Phone Number
Email address
Type of Activity
Date of Activity number of people attending _________Time:
Admission Charge:  Yes  No Food Served:  Yes  No
INSURANCE/ DEPOSIT REQUIREMENT:
A. All individuals, groups, organizations, etc. shall provide a $50.00 Application & Use fee, upon executing
this Agreement. In case of cancellation, a refund may be requested. Upon completion of the activity, a
site inspection will be held.
B. Applications submitted without the $50.00 application fee and the required liability insurance coverage
will not be accepted.
C. There is a required liability insurance coverage of ($300,000 CSL) for the planned activity. A certificate
of liability insurance must accompany this application. If food is to be sold, a product liability policy
will also be required and applicant must contact the Queen Anne’s County Health Department. A copy
of each required document must accompany this application.
REGULATIONS:
A. Groups or individuals who are residents of Centreville or groups and organizations based in Centreville
have first preference when making application to use the park. Fund raising events by Centreville based
groups or organizations are acceptable.
B. All Town of Centreville Parks are open for use from dawn to dusk. Hours may be extended through
approval by the Centreville Town Council.
C. Pursuant to Chapter 7 of the Centreville Town Code, no alcoholic beverages are permitted.
D. Applicant is to be in charge of the event and shall be responsible for the following:
i. Submitting proper application for use of the ground’s facilities;

ii. All trash and decorations must be placed in trash containers provided. If container is full,
then it is the responsibility of the applicant to remove trash, etc. away from the park;
iii. If additional trash pick-up is required for excess trash not removed by the individual/group/
organization using the park, this individual/group/organization shall be charged the current
rate for trash removal;
iv. The building and ground must be clean and in order for the next event.
E. Campfires are not permitted.
F. Overnight camping is not permitted.
G. Any individual or group using the facilities is responsible for any damage above normal wear and
will be assessed the actual cost of any damages incurred. The Centreville Park Advisory Board will
assess damages following the activity and notify the user of any damage within one (1) week. The
individual or group referred to in this agreement further agrees to pay any damages in the amount
assessed by the Centreville Park Advisory Board. Payment for damages incurred will be due and
payable thirty (30) days after receipt of the damage assessment notification.
H. All applications for park use will be subject to the approval of the Town Staff, who will review each
application on an individual basis and determine approval or disapproval.
VIOLATION OF THESE REGULATIONS MAY CAUSE THE DENIAL OF FURTHER USE
By signing this agreement, I understand and am familiar with all policies which regulate the use of this
facility and have made participating members of our organization familiar with the same and I accept full
responsibility.
Name of Responsible Person – Please Print Signature of Responsible Person
Group/Organization Phone Number
TOWN USE ONLY
 Approved
 Approved with the following conditions:
 Denied
Authorized Signature Date
 Payment Received
 Check #
 Cash
 Liability Certificate Received
 Product Liability Certificate (if applicable)
 Approval by QAC Health Department (if applicable)