Park Facilities Rental Application - Field Park Date Submitted Date Format: MM slash DD slash YYYY Complete, accurate and specific information must be entered.GuidelinesThis form must be completely in its entirety and submitted to the Village of Mukwonago Clerk’s Office, 440 River Crest Court, Mukwonago, WI, 53149, for approval. We do not hold reservations until payment is received. You will be notified within 24 hours if the date is not available. “Residents” include Village of Mukwonago residents.Click here to download the Park Usage PolicyFees (choose all that apply)Field Park Pavilion A Resident (Main Pavilion) – 1-49 peopleper day Price: $100.00 Quantity: Field Park Pavilion A Resident (Main Pavilion) – 50-100 peopleper day Price: $150.00 Quantity: Field Park Pavilion A Resident (Main Pavilion) – more than 100 peopleper day Price: $175.00 Quantity: Field Park Pavilion B Resident (Ball Diamond Pavilion)per day Price: $75.00 Quantity: Field Park Pavilion C Resident (Playground Pavilion)per day Price: $75.00 Quantity: Field Park Baseball Field Reservation (for non-athletic organizations)per day Price: $25.00 Quantity: Field Park Baseball Field Lightsper day Price: $30.00 Quantity: Entire Park Residentper day Price: $200.00 Quantity: Electricity and Coordination (Pavilions B or C)per day Price: $10.00 Quantity: Non-Resident FeeAdditional per day Price: $25.00 Quantity: Fee Total $0.00 Deposit (choose all that apply)Field Park Pavilion A and/or entire park depositPrice: $200 Quantity:Field Park Pavilion B and C DepositPrice: $100 Quantity:Key DepositPrice: $10 Quantity:Deposit Total:Applicant InformationName First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Daytime PhoneFaxEmail Organization InformationOrganization Name Name Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneWebsite Is the organization a 501(c)3 organization?YesNoRental InformationEvent Start Date* Date Format: MM slash DD slash YYYY Event End Date* Date Format: MM slash DD slash YYYY Start Time* : HH MM AM PM End Time* : HH MM AM PM Estimated Number of ParticipantsGenerally describe your event and it's purpose.Will you be serving alcohol?If yes, temporary Class B beer and/or wine (picnic) and operator (bartender) licenses are necessary under separate application.YesNoDoes your event involve amplified music?YesNoIf yes, will the amplified music be a:DJBandOtherHours of amplified music:Start Time : HH MM AM PM End Time : HH MM AM PM If you will be using the baseball field lights, what are the times needed?Start Time : HH MM AM PM End Time : HH MM AM PM Please list the number of security staff you will be providing for the event:Will you be erecting any tents, canopies, or other temporary structure(s)?If yes, please provide a plan for their proposed locations. The Fire Department and Building Inspection Department will need to inspect these structures prior to the start of your event. There may be a separate fee for tent inspection.YesNoPlease describe your dumpster/clean-up plan.What other assistance do you foresee needing from the Village (personnel, materials, equipment, etc.)?Insurance RequirementsThe applicant will provide an indemnity bond if the event has 50-149 people per day. The applicant will obtain liability insurance for an event that includes alcohol or has 150 or more people per day. Proof of this insurance, with coverage no less than $1,000,000 which names and endorses the Village, its officers, agents, employees, and contractors as an additional insured party is due no later than 20 days before the event.Are you able to provide these insurance documents, if required?YesNoDeposit RequirementsThe applicant is required to submit to the Village Clerk-Treasurer’s Office a cleaning/damage deposit (amount listed above) each scheduled day of the event (or portion thereof) two months prior to the starting date of the event. That deposit shall be refunded to the applicant, if, upon inspection, all is in order, or a prorated portion thereof as may be necessary to reimburse the Village for loss or cleaning costs. The Village reserves the right to retain the entire deposit if cleanup is not completed satisfactorily in the time frame as specified in the permit. Unless otherwise stated in the permit, the applicant shall be fully responsible for all necessary cleanup associated with the permitted event to be completed within 12 hours after the conclusion of the event. (This deposit is separate from any deposit required for rental of Village parks).Termination of an EventThe Village reserves the right to shut down an event that is in progress if it is deemed to be a public safety hazard by the Police Department, Fire Department, and/or there is a violation of Village Ordinances, State Statutes or the terms of the applicant’s permit. The Village Administrator and/or his/her designee may revoke an approved park facilities use permit if the applicant fails to comply in good faith with the provisions of the permit prior to the event date.CertificationBy signing this form, the applicant certifies authorization to act on behalf of their organization, and hereby agrees to hold the Village, its officers, agents, employees, and contractors harmless against all claims, liability, loss, damage or expense (including but not limited to actual attorney fees) incurred by the Village for any damage or injury to person or property caused by or resulting directly or indirectly from the activities for which the permit is granted. Any change to coverage requires Village approval.Signature - Applicant*Name First Last TitleDate Date Format: MM slash DD slash YYYY