FACILITY USE APPLICATION 

Athletic Fields, Gym & Shelter Rentals 

EVENT AND FACILITY INFORMATION: 

Field / Shelter Requested: ____________________________ Type of Activity: _______________________________

Date: ____________________ Event Hours: Start Time _____________ am/pm End Time ________________ am/pm

Estimated number Participants ____________________

APPLICATION INFORMATION 

Name: ___________________________________ Phone: _____________________ Email: ____________________________

(Print name of responsible person  

Organization Name (if applicable) ______________________________________________________________

Applicants Address __________________________________________________________ 

City ______________________________ State ____________ Zip __________________

ALL RENTALS

• A $15 Clean up fee will be assessed to all reservations. You are responsible for taking your own garbage and general clean-up of area. Once accessed, your fee will be returned to you 7-10 days after event date. 
• In the event of inclement weather, refunds will not be granted for shelter rental. Every attempt will be made to reschedule but is not guaranteed. 
• All responsible persons must clean up the areas that are being used (site subject to inspection by staff) 
• Parking is permitted in designated areas only. No Parking on grass areas. 
• Absolutely no alcoholic beverages permitted on Pickens County Properties. Violators will be ticketed. 
• Electricity is provided at picnic shelter and fields.
• Use of Bounce House must be approved by Dacusville Recreation. A certificate of insurance for $1,000,000 General Liability from vendor naming Dacusville Recreation as additional insured is required. Bounce houses must have generator and cannot be plugged into electrical outlet. Bounce houses with water features are not allowed.

THE PERSON(S) LISTED ON THIS FORM SHALL BE LIABLE FOR ANY LOSS, DAMAGE OR INJURY SUSTAINED BY ANY PERSON BY REASON OF NEGLIGENCE OF THE PERSON OR PERSONS IN ATTENDANCE. ANY DISCREPANCIES BETWEEN THIS APPLICATION AND THE ACTUAL DATE WILL BE CAUSE FOR FUTURE DENIAL OF FACILITY USE AND ADDITIONAL FEES WILL BE ASSESSED. 

I have read and agree to the above facility use application and accept the terms within. 

_____________________________________________________________

Applicant Signature

FOR OFFICE USE ONLY: 

FEE ATTACHED: ___________

PAID (RECEIPT NUMBER) _____________

CHECK __________ CASH _____________

APPROVED BY FACILITIES COORDINATOR: YES_______  NO______