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2. Contact Name*

   Contact Person is responsible for relaying all information to the group, including the TERMS AND CONDITIONS per the permit.

3. Contact Person for the Day of the Reservation*

   This person will be the onsite contact person the day of the reservation who will ensure that all of the TERMS AND CONDITIONS and PARK RULES per the permit are followed.

5. Name of Group
7. Are you a City of Vandalia Resident?*

   1. Yes
   2. No

   (Please note - Butler Township Residents are not City of Vandalia Residents.)

9. Picnic Shelter and Gazebo Reservations are only available to City of Vandalia Residents. Please STOP and do not submit a request.*
   -- Select One --Please STOP and do not submit a request.
11. Address*
13. City*
14. State*
15. Zip Code*
17. Primary Phone Number*
18. Alternate Phone Number
20. Email*
22. 1st Choice Date of Event*
    1st Choice Date of Event
24. 2nd Choice Date of Event*
    2nd Choice Date of Event
26. Requested Time of Event*
    Requested Time of Event
28. Purpose of Shelter or Gazebo Rental*
30. Special Requests
32. Picnic Shelter/Gazebo Rental Requested*

    1. Helke Park - Shelter 1 - Seats 80, 2 charcoal grills, electric, and bathroom facilities. Shelter 1 is south of the restroom building.
    2. Helke Park - Shelter 2 - Seats 60, 1 charcoal grill, electric, and bathroom facilities.
    3. Seger Park Gazebo - Has electricity, but no bathroom facilities.
34. Shelter and Gazebo Terms and Conditions
    Shelter and Gazebo Terms and Conditions (PDF)
36. City of Vandalia Park Rules
    City of Vandalia Park Rules (PDF)
38. Electronic Signature*

    By signing your name here, you acknowledge that you have read and fully understand the SHELTER AND GAZEBO TERMS AND CONDITIONS (PDF) and the CITY OF VANDALIA PARK RULES (PDF). Completion of this application does not guarantee requested date/time.

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40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field