OFFICIAL PERMIT
ORANGE VILLAGE MUNICIPAL FACILITY & COMMUNITY PARK FOR THE USE OF THE BASEBALL
AND SOCCER FIELDS, THE WOODELL ROOM, AND PARK PAVILIONS

[ ] Dubyak Diamond	[ ] Hazlett Field (Pike Drive)	[ ] Soccer Field	[ ] Singer Pavilion
[ ] Pike Drive Pavilion	[ ] Wooddell Room	[ ] Council Chamber

Application Date_______________ Reservation Date(s)_________________________________________________ _________________________________________________________________ Time requested-from/to______________________________________________ Name____________________________________________________________ Address_________________________________________________________ City_____________________________________________________________ Telephone Number___________________Home____________________Work Name of Team_______________________________League________________ For the Purpose of__________________________________________________ Authorization Given By_____________________________________________

CONDITIONS OF PERMIT
The Orange Village ball fields, park pavilions, and the Wooddell Room and Council Chamber may be reserved by
Orange Village Residents or Employees for their use only. The resident/employee of Orange Village who
reserves the facility, must be present at all times during the use of the facility.

The use of Village property is subject to all pertinent state laws and Orange Village Ordinances.

All proceedings shall be orderly.

The holder of this permit shall be responsible for damages to Village property resulting from use herein,
and is expected to report any damages to personnel at the Orange Village Hall.

Orange Village and its officials shall be freed from any liability for damages to persons or property resulting from
the issue of this permit.

Litter and debris shall be cleaned up and placed in the proper receptacles.

Notice of cancellation of areas reserved must be received forty-eight (48) hours prior to the reserved use of the field.

This permit is valid for no more than a period of four (4) hours on any given day.

Resident must have this permit with them at the time of the event.

                                                  ______________________________
                                                  Signature of Resident

Print this form. Send a copy of the completed form to Orange Village Hall - 4600 Lander Rd - Orange Village, Oh 44022
or Fax: 440-498-4404