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Roosevelt City Park Pavilion Reservation Form

  1. Reservation is for

  2. Check the Pavilion and Group Use Fee that applies.

  3. Pavilions and Locations

  4. South Pavilion - Constitution Park

  5. North Pavilion - Constitution Park

  6. Harmston - City Park

  7. Old Mill Pavilion - Old Mill Park

  8. The following are exempt from remitting these fees: Duchesne County School District, Moon Lake Electric, Scout functions and UBIC activities (not class reunions) .

  9. Will you have an inflatable bouncer?

  10. $25 each in addition to the pavilion rental fee (fee charge is for use on grass which may cause damage)

  11. - Facility must be vacated by midnight unless prior approval has been given.
    - Facility must have all trash and debris cleaned up prior to being vacated. Do not leave a large amount of trash overflowing in garbage cans or dumpsters. Excess garbage must be packed out. If the “Group use” is over 300 individuals, it is your responsibility to bring additional garbage cans on site to use during the activity and remove when vacated.
    - If lights are used, they must be turned off prior to vacating the facility.
    - There is to be no swearing or vulgar language.
    - Excessive noise is prohibited at all times. After 10 p.m. no amplified music or sounds will be permitted.
    - No motorized vehicles are allowed on the grass unless prior approval is given by the Parks Department.
    - All Vendors are required to set up their booths in the parking lot areas provided. No vendors are to be allowed on the grass.
    - Excessive abuse to the use of facility will constitute an additional fee of $200.
    - No waterslides are allowed on the hills at the Constitution Park. The grass at the location will be burned by any color of plastic.

  12. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  13. Cash, Check, Money Order and Credit/Debit card is accepted for payment.
    Return completed form with payment to: Roosevelt City Corporation, 255 S State Street, Roosevelt, UT 84066
    Or Fax form in to Roosevelt City, 435-722-5000 then call in to submit payment using your debit/credit card
    Phone: 435-722-5001 Fax: 435-722-5000

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  15. This field is not part of the form submission.