Town of Bethlehem Parks & Recreation

Town of Bethlehem Parks & Recreation Receipt # 378397 Payment Date: 09/11/23 Household: 6239 Elm Avenue Park Joshua Mcwilliam 261 Elm Avenue 9 Woodstream Drive Delmar NY 12054 Delmar NY 12054 Phone: (518)439-4955 Ext: 2131 kristianna.cerullo@gmail.com Visit us on the Web at: www.townofbethlehem.org Reservation Details: Henry Hudson Park, Pavilion HHP Address: 169 Lyons Road, Selkirk, NY, 12158 New Fees Total Fees New Paid Total Paid Amount Due Reserv. Contact: Joshua Mcwilliam 155.00 155.00 155.00 155.00 0.00 Phone Number: (914)588-8482 Reserv. Number: 6736 Status: Firm Purpose: Cub Scout Pack 1232 Fall Event Anticipated Count: 50 Date(s): Sun @ 1:00pm - 6:00pm: 9/24 Facility Comments DIRECTIONS TO FACILITY:(cid:13)(cid:10) 169 Lyons Road, Selkirk. Located off Route 144, turn on Barent Winne Road and follow roadway to bottom of hill, bearing right along river.(cid:13)(cid:10) (cid:13)(cid:10) RESERVATION AGREEMENT:(cid:13)(cid:10) The Reservation Contact listed above is legally responsible for any and all actions of the pavilion users while they are at Henry Hudson Park. This person will be held financially responsible for any and all damages to park property caused by a member of his/her group. This person is responsible for supervising the distribution of any beer and wine. The Town of Bethlehem cannot be involved in purchasing or otherwise procurring beer or wine for any group, selling or dispensing of beer or wine, or supervising its distribution. Beer and wine is restricted to the pavilion area.(cid:13)(cid:10) (cid:13)(cid:10) The Reservation Contact hereby acknowledges that he/she has read, understands and agrees to comply with the guidelines outlined on the attached form. The Reservation Contact further verifies that he/she is 18 years of age or older (21 or older if alcohol is being served).(cid:13)(cid:10) (cid:13)(cid:10) The Reservation Contact hereby requests reservation of the Town of Bethlehem pavilion named above, for the date(s), time(s) and purpose shown. He/she further agrees to hold harmless and completely indemnify the Town of Bethlehem, its officers, agents and employees, in any claim of personal injury or property damage in any way arising from use of this facility.(cid:13)(cid:10) (cid:13)(cid:10) THIS RECEIPT MUST ACCOMPANY YOU DURING USAGE OF THE FACILITY. Special Questions: Reservation Comment Code: Event Type: Print Opt: Site Type: Link to Reservation #: 6736 Display Reservation on WebTrac: No Web Event: No Processed on 09/11/23 @ 9:59am by erf Total New Fees 155.00 Discount Applied 0.00 Total Due 155.00 Total Fees Paid 155.00 Total Paid 155.00 Page # 1 of 3

Town of Bethlehem Parks & Recreation Receipt # 378397 Payment Date: 09/11/2023 Household: 6239 Household Balance Information Overall Household Credit Balance Available 0.00 Overall Household Balance Due 0.00 Payment applied to receipt balance 155.00 Payment applied to service fee 5.04 Payment of: 160.04 Made By:VISA/MC/DISC/AMEX Auth: 672390 Card#: xxxxxxxxxxxx7416 With Reference: A Service Fee has been applied to this transaction. Page # 2 of 3

Town of Bethlehem Parks & Recreation Receipt # 378397 Payment Date: 09/11/2023 Household: 6239 Reservee: Kristianna McWilliam(cid:9)(cid:9)(cid:9)Reservation No: 6736(cid:13)(cid:10) 9 Woodstream Drive(cid:13)(cid:10) Delmar, NY 12054(cid:13)(cid:10) No Phone # Listed(cid:13)(cid:10) (cid:13)(cid:10) FACILITY RESERVATION INFORMATION AND GUIDELINES(cid:13)(cid:10) =================================================================================================================(cid:13)(cid:10) (cid:13)(cid:10) PAVILION USE: The pavilions must be reserved by residents of the Town of Bethlehem or Town of Bethlehem based organizations. The pavilion is to be used for recreational purposes only. The permit must accompany the person(s) responsible to the picnic.(cid:13)(cid:10) (cid:13)(cid:10) SEATING CAPACITY: 150 adults comfortably at one time. IF YOU MOVE ANY PICNIC TABLES FOR YOUR EVENT, YOU MUST PUT THEM BACK TO THEIR ORIGINAL PLACE. ADDITIONAL FACILITIES AVAILABLE: The nearby volleyball court and horseshoe pit are available on a first come, first served basis. A volleyball and horseshoes may be obtained at the Park office, Monday through Friday from 8:30am to 4:30pm. Equipment must be returned to the Park office on Monday following a weekend picnic. The softball field may be reserved for an additional fee.(cid:13)(cid:10) (cid:13)(cid:10) REST ROOMS: Rest rooms are available not far from the pavilion. (cid:13)(cid:10) (cid:13)(cid:10) BARBECUE GRILLS: There are two 12”x18” grills and one large grill pit available. Items needed for cooking must be supplied by the user. When finished using the grill for the day DO NOT EXTINGUISH THE COALS, REMOVE THE COALS, OR POUR WATER ON THE UNIT. Please do not burn anything other than charcoal in the grills.(cid:13)(cid:10) (cid:13)(cid:10) PARKING: All vehicles must park in the parking lot. Vehicles may not park on the grass or the roadway.(cid:13)(cid:10) (cid:13)(cid:10) MOTHER NATURE: Mother Nature has a way of leaving her mark (bird droppings, pine needles, tree sap, etc.) on and around our facilities. We strive to provide a clean picnic environment, however we cannot guarantee it.(cid:13)(cid:10) (cid:13)(cid:10) WATER: Water is available from the rest room sinks.(cid:13)(cid:10) (cid:13)(cid:10) ELECTRICITY: One electrical outlet available in the pavilion. The pavilion is not lit after dark so we recommend you clean up prior to darkness. A generator may be necessary when using large electrically operated cooking equipment.(cid:13)(cid:10) (cid:13)(cid:10) ACCESSIBILITY: The parking lot, eating area and rest rooms are accessible for wheelchairs. Wheelchair accessible picnic tables are also available.(cid:13)(cid:10) (cid:13)(cid:10) BEVERAGES: All beverages must be served in non-glass containers. Glass bottles are not permitted. Beer and wine are the only alcoholic beverages which may be served (must be age 21 or older). Alcoholic beverages may not be sold on premises.(cid:13)(cid:10) (cid:13)(cid:10) MUSIC: Amplified and live music is allowed after 12:00pm at reasonable volume levels only. (cid:13)(cid:10) (cid:13)(cid:10) DECORATIONS: Do not use tacks, nails, or staples on the tables or pavilion. Decorations must be removed. RESTRICTIONS: Firearms, fireworks, unlicensed motorized vehicles and soliciting are prohibited.(cid:13)(cid:10) (cid:13)(cid:10) CLEANUP AND DAMAGES: Cleanup and any damages are the responsibility of the group or individual holding the permit. The Parks and Recreation Department will remove all trash placed in trash receptacles. Please do not leave trash bags outside of the receptacles.(cid:13)(cid:10) (cid:13)(cid:10) CANCELLATION: If you decide to cancel, this office must be notified at least 2 weeks prior to your picnic in order to receive a refund. There is a processing fee of 10% from the amount you paid.(cid:13)(cid:10) (cid:13)(cid:10) ANY VIOLATION OF THE ABOVE GUIDELINES MAY RESULT IN IMMEDIATE REVOCATION OF THE PERMIT AND MAY JEOPARDIZE FUTURE USAGE. ANY QUESTIONS OR CASES NOT COVERED IN THE ABOVE GUIDELINES WILL BE DECIDED BY THE ADMINISTRATOR OF THE PARKS & RECREATION DEPARTMENT. (cid:13)(cid:10) Page # 3 of 3

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