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City of Cleveland

dominique.green@cityofclevelandms.com

100 North Street, PO Box 1439, Cleveland, MS, 38732, US

662-846-1471

BIRTHDAY PARTY RESERVATION REQUEST

Please complete this form to request a birthday party reservation. Completing this form does not guarantee or confirm a reservation. Our staff will check availability and contact you to make the reservation.

Contact Information

Child Information

Desired Party Date

Date Picker

Indemnification Agreement

The person or organization requesting the Birthday Party Reservation shall defend, indemnify and hold harmless the City of Cleveland(including all agents and or/it’s insurer) and all City employees, officers and elected officials from and against any and all claims, demands, actions , cause of action, damages and costs(including attorney fees) arising out or by reason of any event or occurrence relating to or arising out of the party, activity and/or use the City’s facilities or equipment brought on or on behalf of any person or organization against the City (including all employees and or it’s insurers).

The organization/person further covenants and agrees on their own behalf and for the City (including all employees, agents, and/or its insurers) that if any person or organization files a lawsuit or otherwise makes a claim against anyone other than the City(including all employees, agents and/or its insurers) for damages as a result of the event or occurrence  or for the treatment of injuries arising out of the event or occurrence, and if as a result of that suit or claim , claims and/or demands are made against the City (including all employees, agents and/or its insurers) such Organization/Person will indemnify and save the City (including all employees, agents and /or its insurers) from any and  all claims, demands, actions, causes of action, damages and costs (including attorney fees) which the City (including all employees, agents and/or its insurers) incurs in defense of any such claims or demands or becomes obligated to pay anyone as a result of the event  or occurrence or treatment of injuries arising out of the event or occurrence.

The Organization/Person shall further provide its own security at such event.

I agree to the terms set forth in this agreement and will be responsible for any damages or charges incurred as a result of, arising out of,  or related to the event or occurrence.

Signature (Responsible Party)

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