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PARK FACILITY PERMIT APPLICATION <br /> l. Name/AddresslPhone Number of Individual or Organization responsible for <br /> making this application: <br /> Wu Long Karate LLC 1853 Main St. <br /> Name Address <br /> 651-200-3067 Centerville, MN 55038 <br /> Telephone Number City,State&Zip <br /> 2. Please describe your eventlactivity and identify the specific facility/field within <br /> the park you wish to use along with what you are asking from the City: <br /> We would like to have our students along with their parents and sibling, <br /> participate in a foot race with exercise stations around LaMotte Park, <br /> on Saturday morning L8- 2noon)June6,th,2015 <br /> 3. What is the number of people that are involved in your event/activity? 90-100 <br /> 4. What City facilities do you wish to use <br /> Acorn Creek Park Eagle Park <br /> Laurie LaMotte Memorial Park X Hidden Spring Park <br /> (Lighting& Warming House) x Trailside Park <br /> M adult may be requested to take <br /> resparisibNY to lock&unlock restroonu <br /> Cornerstone Park Royal Meadows Park <br /> Tracie McBride Memorial Park City Hall <br /> 5. Please list the date or dates and times you propose to use the facilities: <br /> Saturday June 62015,from 8-12 noon. <br /> 6. Is anyone charged a fee to watch or participate in your event? No fee to watch. <br /> 7. Have you used these facilities before? Yes If so,when? <br /> We had early morning bootcamp last summer. <br /> 8. Are you requesting additional permits or City services? Yes x No <br /> (i.e., Road Closure(s), Temporary Liquor License(s), Firex�orks•Permit or <br /> Burning Permit, Use of lights, bathrooms or porta potties, Park Buildings) <br /> Please describe Use of the restrooms would be nice, with parents with small children_ <br /> w <br /> Depending upon the nature of your event,or if you are requesting City services,you may <br /> be required complete a different application and/or make a deposit to cover city costs. <br /> Matt Claseman <br /> Printed N of Pe on Signing / Date <br /> Signature <br /> ■■■■rrr■r■■r■r■r■■■■r■■■■■■■■■■■ur■r■■■■■■■ru■■■■■r■■r■rr■■rr■r■a■u aa■ <br /> Office Use Only <br /> `\ F <br /> Permit approved by: Date: <br /> Deposit required: $ Receipt# <br /> Form number. 2013.01 PU <br />