Name of Individual / Organization _______________________________________________________

Contact Person if Organization __________________________________________________________

Mailing Address ______________________________________________________________________
                                    (Street)                         (City)                         (State)                               (Zip Code)

Telephone Number ____________________________________________________________________
                                    (Home)                         (Work)                         (Cell / Other)

E-Mail Address __________________________________________________________

Day / Date of Rental ______________________________________________________

Time of Reservation: Time In___________ AM PM Time Out___________ AM PM Total Hours__-_________
**Your time of reservation MUST include your set up and clean up time. Your set up before and clean up after must take place within your rental time.

Type of Rental (Birthday Party, Family Reunion, Youth Dance, Etc.)

_______________________________________
** Depending on the type of rental, a security guard may be hired at the renter's expense if deemed necessary by SBCPRD**

Number of People Expected to Attend _______________ Age Group of People Attending _______________

If room is reserved for minors, how many chaperones will attend _______________
** A minimum of 1 chaperone to 20 children is required.

This is a confirmation of the reservation that I have made with the Statesboro-Bulloch County Parks and Recreation Department. I understand that my reservation is not complete until the rental fee and deposit is paid and a facility reservation contract form is completed. By signing below, I am confirming the above information to be correct and that I have read, understand, and been given a copy of the facility rental procedures and will abide by them.

Renter's Signature ______________________________ Date ____________________

OFFICE USE ONLY

Rental Fee Due: ___________ Paid: YES NO Security Deposit:__________ Paid: YES NO

Permit #_____________

Staff Making Reservation: ________________________________

Today's Date: _________________________________

Key #_________ Key Returned: YES NO Deposit Returned to Renter: YES NO