Special Use Permit Application

St. Charles Park District
Special Use Permit Application

This Special Use Permit application must accompany a park or facility rental agreement form and be forwarded for consideration to the office of the Director of Parks and Recreation, not less than fourteen (14) days prior to the scheduled use. Incomplete applications will not be considered. Information on the application found to be inaccurate or untruthful will cause the application to be denied. If such determination is found after said use, the Park District shall exercise the right to charge in full all applicable fees, process in full any security deposit and/or revoke any future privileges to use Park District parks, amenities and facilities.

Primary Contact's Name

Organization Name (if applicable)

Address

Phone

Event Name

Event Description

Event Date

YYYY

Estimated Number of Participants

Event Setup Time

Event Takedown Time

Actual Start Time For Event

Please type the name of the Outdoor Park/Pavilion you wish to rent below:

Indicate the types of activities to be included in the Special Use Permit (select all that apply):

Cash Transactions - Allows for monetary exchange between patrons & vendors.

Consume, Serve or Sell Alcohol - Requires $150 nonrefundable fee. You must complete the fields below with liquor supervisor details.

Fundraising

Use After Dusk - City of St. Charles ordinance prohibits audible noise after 10pm

Artificial Lighting

Please select

If you chose Cash Transactions above, list specific items to be sold:

If you chose Consume, Serve or Sell Alcohol above, please read the following details:

This application is to request permission to consume, serve and/or sell alcohol on District premises. Issuance of a permit shall be considered subject to the user obtaining dram shop liability coverage for the premises in the amount that is at least equal to the maximum liability amount set out in the Illinois Liquor Control Act, 235 ILCS 5/1‐1 et seq., as well as commercial general liability insurance on an occurrence basis, or such similar insurance approved by the Director, or his or her designee, with limits of at least $1 million per occurrence and $1 million in the aggregate, naming the St. Charles Park District, its Board members, officers, agents, employees, assigns, and any other individual or entity the Park District deems fit as additional insureds thereon on a primary and non-contributory basis.

The Park District reserves the right to require applicant to add any other individual or entity as insured(s) as it deems fit. The user shall provide certificates of insurance to the Director indicating conformity with the obligations imposed herein no less than fourteen (14) days prior to the particular event.

1. Liquor Supervisors (minimum 3 per event) shall monitor the serving and consumption of alcohol at all times during the event.

2. Alcohol cannot be served prior to 10am or after 11pm.

3. Alcohol must be contained within an approved area defined by the St. Charles Park District.

4. For outdoor use, each patron must wear a wristband after having identification checked for legal alcohol consumption age.

5. Permission to obtain permit must be approved by the St. Charles Park District.

6. The applicant must comply with all other laws and regulations, including the St. Charles Liquor Ordinances and licenses pursuant thereto.

Only a catering business may sell alcohol on site and must show proof of a City of St. Charles liquor license. If you are selling alcohol, please list the catering business name, address, phone and liquor license number.

if you plan to consume or serve alcohol, please list the name, address, birthdate and drivers license number of your 3 Liquor Supervisors or the name of the caterer that must have an appropriate City of St. Charles liquor license:

I/We agree to comply with the City of St. Charles and St. Charles Park District policies and regulations regarding the service and consumption of alcoholic beverages on Park District premises.

I/We shall indemnify, defend, and hold harmless the St. Charles Park District, its Board members, officers, agents, employees, assigns, and any other individual or entity the Park District deems fit from any and all claims, demands, actions, expenses, or suits of any kind arising out of or in connection with the rental and use of St. Charles Park District facilities. Further, no Indemnitee shall be liable in any manner to the applicant(s), its directors, officers, agents, employees, invitees, or visitors for any injury or damage to applicant(s), applicant’s directors, officers, agents, employees, invitees or visitors, or their property, caused by the criminal or intentional misconduct, or by any act or neglect of third parties or of applicant, applicant’s agents, employees, invitees, or visitors, or of any other user.

I certify that the information provided in this contract is correct to the best of my knowledge, and I further understand that if any information is found to be false I may forfeit my fee and/or deposit.

I, as the authorized renter, have read, understand and accept all of the information stated on this contract, in its entirety, and agree to abide by it.

Signature of Applicant (applicant must be age 21+)

Type your name as your digital signature and check the box below:

Click here if you accept these terms.

* = Required Field

Verification