Stationary Float / Light Display Application
EVENT DATE: Saturday, December 11, 2021, 5-8pm
Displays set by 4:30pm * Drive Thru begins at 5:00pm
WHERE:  Stringham Park, 78 Stringham Road, LaGrangeville NY 12540
Contact us at recreation@lagrangeny.gov or (845) 452-1972 with any questions.

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Organization/Individual Name *
Organization Address *
Organization Website *
Organization Facebook Page *
Organization Instagram *
Lead Contact Name *
Lead Contact Email *
Lead Contact Phone Number *
How would you like to participate? *
Required
Type of Display(s) *
Required
Design Theme (please incorporate a "200" in your design in honor or LaGrange's Bicentennial) *
I have read and understand the following Event Guidelines set in place for the LaGrange Festival of Lights Drive-Thru. *
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PERMISSION/AGREE TO HOLD HARMLESS
As the participant signed below, knowing fully that the Town of LaGrange Parks and Recreation Department provides the program activity, and or special event and all aspects associated with these being; Facility(s), Instructor(s), Equipment and Supervision, I hereby: 1. Agree to furnish my own insurance in case of injury, 2. Assume all risks and responsibilities of possible injury invovled with participating in this program, 3. Testify that I am in sound health and capable of participating in the registered program, 4. Further agree to indemnify and hold harmless the Town of LaGrange, Parks and Recreation Department or employees, to include volunteers, from liability resulting from my participation in this program, activity or special event.
Signature of Individual.  Please type full name here and click "Accept" in the following question if you have read the Permission/Agree To Hold Harmless statement above. *
By clicking "Accept" below, I confirm my intent to sign this agreement electronically. *
I understand this application does not ensure entry.  I understand this application will be reviewed and approved or not approved by Director and I will receive confirmation within 7 days. *
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