This Request is only for reservation of the West Veteran's Park Picnic Shelter. All other shelters cannot be reserved.

The hereinafter name, organization, or person requests Administrative permission, as provided in Sec. 12.28.030, Great Bend Code of Ordininances, to render a program or function in a Great Bend, Kansas Park within the following specified limits.

Organizations or Person's Name*

Organization or Person's Address*

Person Responsible for the Program at Vets Shelter*

Address of Responsible Person*

Telephone Number of Responsible Person*

Type of Program or Function to be held at Shelter*

Date of the Event (mm/dd/yyyy)*

Start Time of Event*

End Time of Event*

Today's Date (mm/dd/yyyy)*

By checking the box below I hereby affirm that proposed program or function is "consistent with the rights of persons to assemble for their mutual welfare and shall not be inimical to or subversive of the objectives and purposes of the governments of the United States, State of Kansas, or the City of Great Bend;"*

I agree

Authorization that the Shelter has been reserved shall come from either the Director or Public Lands or the Park Supervisor. The Shelter is available on a first come first serve basis. Please provide the e-mail address in which you can be notified if the shelter is available.*