Online Application for Special Use Permit

Submission of this application does not constitute approval to use a picnic shelter, facility or parks location. This application will be reviewed and approved before a Special Use Permit is issued for your event. Application must be made at least 3 weeks prior to an event to allow time for processing to issue a Special Use Permit.

For Athletic Field reservations, please call (540) 387-6078.

Applicant Information:

NAME OF ORGANIZATION: 

CONTACT PERSON:           

STREET ADDRESS:            

CITY:       STATE:     ZIP:  

HOME PHONE W/ AREA CODE:      

WORK PHONE W/ AREA CODE:  

FAX NUMBER:   

 

Event Information:  

Briefly describe your outing/event below. Include all activities as well as any special requests and/or needs. (This will be addressed in your permit, if approved.)

ESTIMATED NUMBER OF PEOPLE IN ATTENDANCE:  

PREFERRED PARK/LOCATION: 

PREFERRED DATE: 

SET UP TIME:     CLEAN UP TIME: 

Is there a need to have vehicle access to the shelter? YES  

If checked YES above, please indicate for what purpose: (accommodation for individuals with disabilities, catering, exhibits, displays, entertainment, etc.)

Do you plan to have any registration or attendance fees?   YES  

Amount of Fees to be charged: 

Fees to be Paid to Whom?:  

Due to County Ordinance, any registration fees, to be collected on site, must have prior approval by the Director of Parks, Recreation &  Tourism.

Will You Be Having Any Inflatable Activities (i.e Moonbounce, etc) or other amusement rides at your event?

If you plan to have any of the activities below at your event, you must present Certificates of Insurance from yourself and any vendor on premises, listing Roanoke County Board of Supervisors as the insured party, upon final payment and reservation for your event. 

    Moon Bounce or other inflatable activities 

    Other amusement rides.

            Please list:

 
Disclaimers

Roanoke County Parks, Recreation & Tourism reserves the right to require a staff person to be present to coordinate your activity. Depending on the site and type of your activity, you may be responsible for any direct expenses the Department incurs as a result.

Name of Applicant:     

E-mail Address:           

If you have questions about this form, please e-mail prtinfo@roanokecountyva.gov or call (540) 387-6078. Submission of this application does not constitute approval to use a facility or location. This application will be reviewed and approved before a Special Use Permit is issued for your event.

  
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