Stationary Float/Light Display Application
EVENT TIME: Saturday, December 12, 2020, 5-8pm
Displays set by 4:30pm * Drive Thru start: 5:00pm
Contact us at
recreation@lagrangeny.gov
or (845) 452-1972 with any questions.
DEADLINE FOR APPLICATIONS: December 8, 2020, 11:59pm
* Required
Email address
*
Your email
Organization/Individual Name
*
Your answer
Organization Website/Social Media Page
Your answer
Organization Address
*
Your answer
Lead Contact Name
*
Your answer
Lead Contact Email
*
Your answer
Lead Contact Phone Number
*
Your answer
How would you like to participate?
*
Stationary float/light display with attendant (stay with display)
Stationary float/light display no attendant (set up and come back after)
Light Sponsor - make a donation for light display created by us with your organization's sign
Donate gift cards, holiday lights, inflatables, generators, candy or other items for goody bags
Required
Type of Display
*
Car
Van
Truck
Trailer
Firetruck
Tow Truck
Tent
Other:
Required
Design Theme
Your answer
If donating supplies, what will you be donating? Please have to Recreation office at Town Hall by 12/8.
Your answer
Number of Display attendants (limit 10). You MUST be able to social distance within your group.
Your answer
I have read and understand the Event Guidelines set in place for the Festival of Lights Drive-Thru Edition.
Yes
No
PERMISSION/AGREE TO HOLD HARMLESS
As the participant signed below, knowing fully that the Town of LaGrange Parks and Recreation Department provides the program activity, and or special event and all aspects associated with these being; Facility(s), Instructor(s), Equipment and Supervision, I hereby: 1. Agree to furnish my own insurance in case of injury, 2. Assume all risks and responsibilities of possible injury invovled with participating in this program, 3. Testify that I am in sound health and capable of participating in the registered program, 4. Further agree to indemnify and hold harmless the Town of LaGrange, Parks and Recreation Department or employees, to include volunteers, from liability resulting from my participation in this program, activity or special event.
Signature of Individual. Please type full name and click "Accept" in following question if you have read the Permission/Agree To Hold Harmless statement above.
*
Your answer
By clicking "Accept" below, I confirm my intent to sign this agreement electronically.
*
Agree
Do Not Agree
Required
I understand this application does not ensure entry. I understand this application will be reviewed and approved or not approved by Director.
*
Agree
Do Not Agree
Required
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Forms
