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2. Policies
   Park Shelter Use Policies (PDF)
4. "Park Shelter User(s)"
   "Reservation & Hold-Harmless and Waiver of Liability Agreement"
6. (Print Name)
7. (Print Address)
9. (Print Phone Number)
10. Provide Primary Vehicle Description
12. (Specify Shelter to Reserve)
13. (Date / Time Reservation)
14. (Approximate Number in Party)
16. (Specify Primary Activity For Which Shelter is to be Reserved)
18. (Date Fee Paid)
19. (Receipt Number)
20. (Exempt)
21. (City Initials)
23. The listed party on this form hereby agrees to the following:
    
    1. I (we) shall immediately reimburse the City for any damages that may occur to 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 Park Committee, City of LeClaire, and the State of Iowa which govern such activities and / or use of said public property.
    
    Further, the above-listed party and any person(s) claiming through or under the undersigned 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, expenses, (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 a park shelter and the surrounding park grounds.
25. Date
    Date
26. Date of Birth
27. Electronic Signature
    By typing your name, you 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 has been provided with a copy of this form.
    
    - 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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