Roosevelt & Ruth Memorial Park Reservation Request Form
Complete and submit this order request form. We will contact you to confirm park availability and to discuss any specific needs before the order is completed. If you have questions please contact us at 910-250-8764 (phone) or info@rooseveltandruthfoundation.org (email).
Contact information
Name *
Your answer
Address *
Your answer
City/State/Zip Code *
Your answer
Phone number *
Your answer
E-mail *
Your answer
Date of Event *
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Facility (Please Check One) *
Required
Event Type *
Your answer
Event Date *
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Event Time (Select One) *
Required
Special Needs (Note: Fees may apply)
Donation: $50-half day per 4-hour segment / $100 Full Day
Total Amount (Enter amount) *
Your answer
Terms of Agreement:
• Notice of cancellation is required 15 days prior to event to receive a refund. §
• Reservation transaction must be completed at least 5 days prior to reservation date/time when reserving
• Reservations must be coordinated directly with an administrator of the Roosevelt & Ruth Marlow Foundation
(910) 250-8764
• The sale of any tangible objects or merchandise within the park is prohibited without permission from
the R&R Foundation.
• The Park is not officially reserved until payment in full has been received and paid receipt is issued.
I understand that this Reservation Agreement grants me use of the picnic shelter /park area for the duration
of the period in this Agreement.
• I understand that I am responsible for cleaning the premises and disposing of all garbage on site
• No alcohol is permitted in the Park.
• No Parking in playground area.
• Solicitation of funds or activities that solicit funds must be approved
Disclaimer:
I hereby agree to the information contained in this Agreement and to abide by all terms listed herein. The Roosevelt & Ruth Marlow Educational and Recreational Inc. and its agents shall not be responsible for personal injuries, or property damage that may arise out of this reservation agreement.
e-Signature (Enter applicant name) *
Your answer
Date *
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Payment Method: (Check or Money Order accepted)
Make Payment To: Roosevelt & Ruth Foundation, PO Box 26, Ash, NC 28420
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