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Shelter Reservation Agreement

Parks and Recreation Department
618-242-6890 parksandrec@mtvernon.com

Name of Applicant, Organization or Event

Address

Phone Number

Shelter Requested

Kiwanis North (72 persons)

Dawson Park (72 persons)

Veterans Park South (72 persons)

Veterans Park West (72 persons)

Rental Sessions ($15.00 per session)

7 a.m. - 2:30 p.m.

3 p.m. - 10:30 p.m..

Rental Date(s)

Type of Event

I have read, understand and agree to abide by the Rules for Shelter Usage for the City of Mt. Vernon.

For Office Use Only

Date Received: Staff:

Total Fees Due:

Fees Paid: Staff: Date: Balance Due: