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2. Levee Pavilion Use
   Levee Pavilion Use Guidelines and Reservation (PDF)
4. Levee Pavilion Shelter Reservation & Hold-Harmless and Waiver of Liability Agreement
   The following party hereby requests to reserve the LeClaire Levee Pavilion:
6. (Print Name - Individual or Organization)
7. Print Address)
9. (Print Home Phone Number)
10. (Provide Primary Vehicle Description)
12. (Print Work Phone Number)
13. (Date / Time Reservation)
14. (Approximate Number in party)
16. (Specify Primary Activity for Which Shelter is to be Reserved)
17. ($25 Damage / Clean-Up Deposit)
    Exempt: city / community non-profit entities
19. $10 Non-Resident Use Fee
20. $25 / day Pavillion Use Fee. Commercial "for profit" and / or "Fund Raising" activities
    Exempt: "benefit" fund raising
21. $25 / day Kitchen Use Fee. Commercial "for profit" and / or "Fund Raising" activities
    Exempt: "benefit" fund raising
22. (City Initials)
24. The above-listed party hereby agrees to the following:
    
    1. I (we) shall immediately the City for any damages that may occur to the shelter and / or surrounding area arising out of the use of the shelter and / or surrounding area during the time that the shelter is reserved.
    
    2. I (we) shall be responsible for the actions of all persons attending the activity during the time that the shelter is reserved.
    
    3. I (we) shall at all times adhere to the rules, regulations and laws of the LeClaire Levee Board, City of LeClaire, and the State of Iowa which govern such activities and / or use of said public property.
    
    Further, the listed party and any respective sureties, covenant and agree to protect, indemnify, and hold harmless the City of LeClaire, Iowa, its departments, agents, employees, and assigns from any and all actions, claims, demands for damages, (including attorney's fees), or liability of any kind or nature whatsoever, which may be occasioned by or arising out of any accident or other occurrence causing or inflicting injury and / or damage to any person(s) or injury and / or damage to property, which may result from the use of Levee Pavillion and the surrounding riverfront levee grounds.
26. Date
    Date
27. Electronic Signature
    I agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
29. - Please keep a copy of this reservation form and have it available with you on the day(s) when you are scheduled to reserve the shelter.
    
    - The LeClaire police department has been notified of your reservation and been provided with a copy of this form.
    
    - Every effort will be made to insure that the pavilion is clean for your use. However, it is also used by the general public when not being reserved and may not be up to your expectations on the day of your reservation.
    
    The city of LeClaire reserves the right to terminate this reservation and the rights conferred herewith at any time for any violation of the rules and regulations governing the use of these facilities and / or for any violation of any local, state, or federal statute.
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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

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