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Date of Permit
Permittee Name
Permittee Address
Permittee Email
Rental Date
Rental Time
Total Fee Amount ($)
Fee Due Date
Purpose of Rental / Event Type
Rental Duration
—Please choose an option—$200 resident$300 non-resident$50 civic
Will Alcohol Be Sold?
YesNo
If Yes, Upload Proof of Liquor Liability Insurance
Permittee Age Confirmation
I confirm I am at least 21 years of age and will be present during the rental.
Rental End Time Agreement
I agree to vacate the premises no later than 10:00 p.m.
Decoration Rules Agreement
I agree not to attach decorations or equipment with nails, screws, staples, tacks, or adhesive tape.
Liability Agreement
I agree to indemnify and hold harmless the City of Au Gres.
Terms & Conditions
All other terms and conditions of the Pavilion Rental Permit apply, including security deposit, cleaning, trash removal, picnic table return, and cancellation policy.
I have read and agree to the terms and conditions.
Digital Signature / Full Name
Date of Signature
