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2020 Park Permit Application Form

  1. We accept:

    •Valid State ID or Drivers license

    •Rental or Lease Agreement

    •Current Utility Bill

  2. Admission Charge?*
  3. Are you having any type of inflatables?*
  4. Proof of insurance is required for all inflatables. Failure to inform us or provide proof of insurance will result in forfeiture of your deposit!
  5. WAIVER RELEASE FORM - COVID-19

    CITY OF EAST CHICAGO DEPARTMENT OF PARKS AND RECREATION 2020 ACKNOWLEDGMENT AND WAIVER OF LIABILITY NOTICE AND INSTRUCTIONS FOR COMPLETING THE CITY OF EAST CHICAGO DEPARTMENT OF PARKS AND RECREATION’S ACKNOWLEDGMENT AND AGREEMENT FOR ASSUMPTION OF ALL RISKS, AND WAIVING AND RELEASING ALL CLAIMS FOR PERSONAL INJURIES AND PROPERTY DAMAGES DUE FROM THE ACCIDENTAL EXPOSURE TO SARS-CoV-2, COVID-19, MIS-C & OTHER PANDEMIC ILLNESSES. CAREFULLY READ THIS DOCUMENT AND THE ATTACHED ACKNOWLEDGEMENT AND AGREEMENT FOR ASSUMPTION OF ALL RISKS, AND WAIVING AND RELEASING ALL CLAIMS FOR PERSONAL INJURIES AND PROPERTY DAMAGES DUE FROM AN ACCIDENTAL EXPOSURE TO SARS-CoV-2, COVID-19, MIS-C & OTHER PANDEMIC ILLNESSES AT A CITY OF EAST CHICAGO PARKS AND RECREATION DEPARTMENT PROGRAM OR EVENT (“WAIVER”) . THE ATTACHED WAIVER AFFECTS IMPORTANT LEGAL RIGHTS YOU, YOUR CHILD(REN) AND/OR YOUR OTHER FAMILY MEMBER(S) AND/OR DEPENDENT(S) MAY HAVE IN THE EVENT YOU, YOUR CHILD(REN), AND/OR OTHER FAMILY MEMBER(S)/DEPENDENT(S) BECOME EXPOSED TO, INFECTED WITH, OR SUSTAIN BODILY INJURIES AND/OR PROPERTY DAMAGE FROM HIGHLY CONTAGIOUS VIRUS(ES) AND DISEASES. I.Background and Purpose The CITY OF EAST CHICAGO and the CITY OF EAST CHICAGO DEPARTMENT OF PARKS AND RECREATION (hereinafter jointly and separately referred to in the attached WAIVER as the CITY OF EAST CHICAGO sponsor(s) and offer(s) to the public the option of participating in or attending a variety of indoor and outdoor physical, social and educational programs and activities, including competitive and non-competitive sports and sporting events, organized leagues, day camps, games, and instructional/training programs and camps (collectively referred to hereinafter and in the attached WAIVER as the “DEPARTMENT OF PARKS AND RECREATION PROGRAM(S)”). These RECREATION PROGRAM(S) are held on CITY OF EAST CHICAGO property and other public and semi-public places that are accessible to large numbers of people on a daily basis. Due to the ongoing COVID-19 pandemic, and until further notice, any adult age 18 or older wishing to enroll themselves, their child(ren) or any other dependent(s) family members into a CITY OF EAST CHICAGO PARKS AND RECREATION DEPARTMENT PROGRAM, or seeking to otherwise voluntarily participate in a CITY OF EAST CHICAGO PARKS AND RECREATION DEPARTMENT PROGRAM as a coach, counselor, instructor, referee, official, or volunteer, is required to complete, sign and return this WAIVER TO: VANESSA HERNANDEZ-ORANGE, or designated member of her staff, by no later than the day of , 2020, or the enrollment deadline set for the specific PARKS AND RECREATION PROGRAM in which participation/access is sought. Enrollment and participation in any CITY OF EAST CHICAGO PARKS AND RECREATION DEPARTMENT PROGRAM(S) and permission to access any CITY OF EAST CHICAGO facilities/property and equipment to participate in or use at a PARKS AND RECREATION PROGRAM is expressly conditional on properly completing, signing, and returning this WAIVER in a timely manner. Access to and participation in any CITY OF EAST CHICAGO PARKS AND RECREATION DEPARTMENT PROGRAM(S) and/or CITY OF EAST CHICAGO facilities, property and equipment used in a PARKS AND RECREATION PROGRAM may be denied or revoked at any time for failure to properly complete, sign and return this WAIVER. II.Acknowledgment of Agreement ACKNOWLEDGEMENT AND AGREEMENT FOR ASSUMPTION OF ALL RISKS, AND WAIVING AND RELEASING ALL CLAIMS FOR PERSONAL INJURIES AND PROPERTY DAMAGES DUE FROM AN ACCIDENTAL EXPOSURE TO SARS-CoV-2, COVID-19, MIS-C & OTHER PANDEMIC ILLNESSES AT A CITY OF EAST CHICAGO PARKS AND RECREATION DEPARTMENT PROGRAM OR EVENT I/WE, (hereinafter “I/WE), acknowledge and represent that I/WE am/are the parent(s)/legal guardian(s) of: (hereinafter referred to as the “PROGRAM PARTICIPANT(S)”) By signing this WAIVER and initialing each page, I/WE acknowledge and agree that I/WE have been had an opportunity to receive a copy upon request, to read and now fully understand: (i) the Center for Disease Control’s (“CDC”) and the State of Indiana’s Department of Health’s information and guidelines for preventing/protecting against, and recognizing the signs and symptoms of, infection for SARS-CoV-2 (the virus that causes COVID-19) and the related illnesses and medical conditions called COVID-19 and Multisystem Inflammatory Syndrome in Children (“MIS-C”)(collectively the “PANDEMIC ILLNESSES”); and the CITY OF EAST CHICAGO DEPARTMENT OF RECREATION’S “COVID-19 Operational Plan” for 2020. I/WE further acknowledge, understand and agree that: 1.The CDC and ISDH have determined that the PANDEMIC ILLNESSES are highly contagious viruses, diseases and medical conditions. 2.Exposure to or infection from these PANDEMIC ILLNESSES may cause serious permanent bodily injury, including respiratory failure, cardiac arrest, and death in healthy persons of all ages. 3.These PANDEMIC ILLNESSES are new. The standards and recommendations on how to prevent and protect against the risk of exposure to infection and the spread of these PANDEMIC ILLNESSES continues to change as more data becomes available. 4.These PANDEMIC ILLNESSES presently exist and remain prevalent throughout all areas of the State of Indiana and continue to infect persons and spread throughout all counties and local communities, including the residents of the CITY OF EAST CHICAGO. 5.These PANDEMIC ILLNESSES have a high probability of spreading to person(s) who are either in direct contact with, or in close proximity to (within about 6 feet or 2 meters) an infected person. 6.The CDC and ISDH believe these PANDEMIC ILLNESSES are most likely to spread from person to person by droplets produced into the air when an infected person coughs, sneezes, talks or otherwise moves air out through their nose and mouth; and from touching/contacting surfaces on which droplets containing the virus exist. 7.There is no known vaccination(s), immunization(s) or cure for these PANDEMIC ILLNESSES. 8.The CDC and the ISDH maintain that the best way to prevent and protect against infection and/or spread of these PANDEMIC ILLNESSES is to self-quarantine and to avoid contact with other individuals, large gatherings and spending time in public places and buildings. 9.CITY OF EAST CHICAGO and the CITY OF EAST CHICAGO DEPARTMENT OF PARKS AND RECREATION (CITY OF EAST CHICAGO sponsor(s) and offer(s) to the public the option of participating in or attending a variety of indoor and outdoor physical, social and educational programs and activities, including competitive and non-competitive sports and sporting events, organized leagues, day camps, games, and instructional/training programs and camps (“RECREATION PROGRAM(S)”) which are essential to the social, physical, educational and character development and the mental and physical health of the public. 10.Attending or participating in any CITY OF EAST CHICAGO PARKS AND RECREATION DEPARTMENT PROGRAM poses an inherent risk of infection and a heightened risk of injury from and exposure to these PANDEMIC ILLNESSES regardless of the measures taken by the CITY OF EAST CHICAGO: (i) to avoid close contact with other persons, including infected persons; (ii) to disinfect CITY OF EAST CHICAGO facilities, equipment and public property; and (iii) to discover, contact trace, and quarantine infected persons and/or persons exhibiting signs and symptoms of infection of these PANDEMIC ILLNESSES. 11.Attending and/or participating in a CITY OF EAST CHICAGO PARKS AND RECREATION DEPARTMENT PROGRAM may also increase the risk of exposure to these PANDEMIC ILLNESSES and the further spreading of these PANDEMIC ILLNESSES to other family members, PROGRAM PARTICIPANTS, and third persons. By signing this WAIVER, I/WE do further acknowledge the contagious nature of these PANDEMIC ILLNESSES, and that an inherent and heightened risk of danger to infection and exposure to these PANDEMIC ILLNESSES exists for all PROGRAM PARTICIPANTS, persons and other participants attending any CITY OF EAST CHICAGO PARKS AND RECREATION DEPARTMENT PROGRAM at this time. I/WE acknowledge and agree to voluntarily assume all risks that I/WE, the PROGRAM PARTICIPANT(S), and our other family member(s) may be exposed to or infected by these PANDEMIC ILLNESSES by attending or participating in any CITY OF EAST CHICAGO PARKS AND RECREATION DEPARTMENT PROGRAMS; and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I/WE understand that the risk of becoming exposed to or infected by these PANDEMIC ILLNESSES at a CITY OF EAST CHICAGO PARKS AND RECREATION DEPARTMENT PROGRAM may result from the actions, omissions or negligence of myself and others, including, but not limited to the CITY OF EAST CHICAGO’S officials, officers, employees, and volunteers; and other participants/attendees of the RECREATION PROGRAM and their families. I/WE, on behalf of ourselves, the PROGRAM PARTICIPANT(S) and the other dependents of my/our household, I/WE voluntarily agree to assume all of the foregoing risks, and do accept sole and complete responsibility for any and all injuries, damage(s) and other losses to the PROGRAM PARTICIPANT(S), my/our other dependent(s), the other members of my/our family, and/or to myself/ourselves for attending or participating in a CITY OF EAST CHICAGO PARKS AND RECREATION DEPARTMENT PROGRAM, including for all bodily injuries, disabilities, permanent disabilities, deaths, illnesses, damages, losses, claims, demands, liabilities, medical treatment and expenses, attorneys fees, costs of suit and/or expenses of any kind that is incurred in connection with attending or participating in any CITY OF EAST CHICAGO PARKS AND RECREATION DEPARTMENT PROGRAM. I/WE, on behalf of myself/ourselves, the PROGRAM PARTICIPANT(S), my/our other household members and/or dependents, HEREBY RELEASE, COVENANT NOT TO SUE, DISCHARGE, WAIVE AND HOLD HARMLESS THE CITY OF EAST CHICAGO, THE CITY OF EAST CHICAGO DEPARTMENT OF PARKS AND RECREATION, AND EACH OF THE CITY OF EAST CHICAGO’S OFFICIALS, OFFICERS, EMPLOYEES AGENTS, VOLUNTEERS AND REPRESENTATIVES FOR AND FROM ANY AND ALL CLAIMS, DAMAGES, DEMANDS, LOSSES, LIABILITIES, ACTIONS, COSTS AND EXPENSES OF ANY KIND ARISING OUT OF OR IN ANY WAY RELATING TO THE ACCIDENTIAL AND/OR NEGLIGENT EXPOSURE TO THESE PANDEMIC ILLNESSES FROM ATTENDING OR PARTICIPATING IN ANY CITY OF EAST CHICAGO PARKS AND RECREATION DEPARTMENT PROGRAM(S). I/WE UNDERSTAND AND AGREE THAT THIS WAIVER AND RELEASE INCLUDES ANY AND ALL CLAIMS BASED ON THE ACTIONS, OMISSIONS, OR NEGLIGENCE OF THE CITY OF EAST CHICAGO, THE CITY OF EAST CHICAGO DEPARTMENT OF PARKS AND RECREATION AND THE CITY OF EAST CHICAGO’S OFFICIALS, OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES, REGARDLESS OF WHETHER INFECTION FROM THESE PANDEMIC ILLNESSES OCCUR BEFORE DURING OR AFTER PARTICIPATION AND/OR ATTENDANCE IN ANY OF THE CITY OF EAST CHICAGO PARKS AND RECREATION DEPARTMENT PROGRAM(S). By signing this agreement, I/WE further acknowledge that I/WE have read and discussed with the PROGRAM PARTICIPANT(S) the provisions of this WAIVER and the dangers and risks associated with attending and/or participating in any of the CITY OF EAST CHICAGO’S PARKS AND RECREATION PROGRAM(S); the PROGRAM PARTICIPANT(S) fully understand(s) and appreciate(s) these dangers and risks; and the PROGRAM PARTICIPANT(S) voluntarily wishes to enroll in, participate and otherwise attend the CITY OF EAST CHICAGO’S PARKS AND RECREATION PROGRAMS. This WAIVER does not supersede, circumvent, or cancel the CITY OF EAST CHICAGO PARKS AND RECREATION DEPARTMENT’S Primary Agreement or Rules and Regulations for any of its Programs. If any part of this WAIVER is found by a court of competent jurisdiction to be invalid, the remainder of this WAIVER release from liability shall nevertheless remain in full force and effect and the offending provision or provisions severed here from. I/WE, have read and accept the terms and conditions of this Waiver, and acknowledge and agree that it shall, to the fullest extent allowed by law, be effective upon me and my child(ren), and our respective heirs, personal representatives, estates and family members.

  6. Digital Signiture*
  7. RULES AND REGULATIONS
  8. A. GENERAL REQUIREMENTS
    The building and grounds of the public parks of the Parks and Recreation Department shall be available for public use insofar as they may be used as follows:

    1. For recreational, educational, civic requirements, and entertainment programs sponsored by responsible citizens is intended to mean a person at least 21 years of age, property owner of this park district and/or a person otherwise financially responsible.
    2. Facilities shall be available for public use outside of hours required by activities of the Parks & Recreation Department.
    3. Park Property shall not be used for the breaching, promoting, disseminating or furtherance of any authority or of subversive nature, intended to threaten or undermine, or overthrow the constitutional form of government of the United States of America of the State of Indiana.
    4. Park employees may not use park property or facilities for personal gain.
  9. B. PROCURAMENT OF PERMIT
    Upon application to the Parks & Recreation Department facilities will be made available whenever possible to groups and other organizations and persons meeting the following rules and regulations.

    1. The use of facilities for any purpose whatsoever shall be cleared through the Parks and Recreation Department. Upon completion of the application, the applicant shall then present it to the Park Office for determination of fees, responsibilities and services required by the Parks & Recreation Department.
    2. The use of the facilities will be strictly banned to areas designated or intended in the permit. All persons participating in or pertaining to the activity will hold the applicant and his/her organization responsible for the compliance of these rules. Failure to comply with these rules and regulations will be sufficient reason to cancel future privileges of park facilities.
    3. The Director for good cause may cancel all permits issued by the Parks and Recreation Department.
    4. Gambling, drinking alcohol, or the possession of intoxicants within the park facilities or on the park property is specifically prohibited.
    5. No furniture or equipment shall be used or moved without express approval on the permit.
    6. The Parks & Recreation Department and its employees shall not be responsible for injuries, damage to or loss of property upon park premises sustained by the applicant participating in a program or to a patron of any program.
    7. It may be necessary for some organizations, depending on the size of the group, to have security on duty. These personnel shall be procured by the Parks & Recreation Department and charged to the applicant.
    8. Established parking areas shall be used for all vehicles that are parked on park property. At no time shall areas that are in grass, shrubs, etc. be used for parking.
    9. Any permit may be revoked for misrepresentation in the application or violation of terms and conditions of this application concerning policy, ordinances, rules, regulations and laws of the State of Indiana and City of East Chicago.
  10. C. USE OF PARK PROPERTY
    1. Concession or refreshment stands shall not be constructed, neither shall refreshments be distributed or concessions authorized in any fashion without the expressed approval of the Parks and Recreation office.
    2. Invasion of any equipment, bleachers, fences or buildings of any nature shall not be permitted without approval in writing by the Parks and Recreation office.
    3. Buildings will not be available for use including toilet facilities unless specifically requested.
    4. All vehicles parked on park property will be towed and you will not receive your deposit back.
  11. D. RENTAL FEES
    1. Rental fees shall be to the discretion of the Park board.
    2. You must call
    3 weeks before any cancellations in order for you to receive your deposit back. Otherwise your deposit will be kept.
  12. E. LOAN OF PARK EQUIPMENT
    1. No park equipment will be loaned to individuals or organizations outside the Park District except by written permission from the Director.
    2. In the event equipment is loaned, the recipient will be responsible to see that the equipment is returned in good condition.
  13. F. PARK PROPERTY UPKEEP
    1. All users of park department property or facilities shall assume the responsibility to leave said property in its original state.
  14. G. RAIN: NO REFUNDS, RAIN CREDIT
    1. If you do not have event due to rain on the day of reservation, you must contact park office within 2 business days after your reservation date to inform them of your cancellation in order to qualify for a rain credit date. A rain date will be given to be used within one year of scheduled picnic date.
    2. Rain Credit will only apply to rentals of general picnic areas and shelters. Rain Credit does NOT apply to Pavilion.
  15. Digital Signiture*
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