The City of Wellston, Ohio
RECREATION DEPARTMENT
Facility Request Form

Print this form on your computer, fill it out, and mail to:
Wellston Recreation Department, 203 E. Broadway St., Wellston OH 45692-1521

Facility needed_________________________________

Date and Time Needed___________________________


THE AGREEMENT:

1. I agree to release the Wellston Recreation Department from liability
for any lost, stolen, or damaged personal property or for any injuries that may occur.

2. I certify that all participants are at least 18 years old and no longer in high school.

3. I understand and agree that no alcoholic beverages and illegal drugs
will be permitted in the park and ball field areas, including in our parking lots.

4. I understand that I am responsible for all trash clean up and for damages.

5. I understand if I fail to follow this agreement, my privilege of reserving
Wellston Recreation facilities and grounds may be suspended.

6. I understand legal action may be taken if I or anyone else in my tournament
violate the alcohol/drug rule, or damage city property in any way.

7. I have read and understand this agreement, and I agree to comply with the rules.



SIGNATURE______________________________________________

DATE____________________________________________

ADDRESS_________________________________________

PHONE NUMBER___________________________________


Form R6
WRD-05/rbc