EL SEGUNDO RECREATION AND PARKS DEPARTMENT
401 Sheldon Street
(310) 524-2700
FAX (310) 647-4223
**HILLTOP / ACACIA PARKS**
RESERVATION REQUEST FORM
PLEASE READ AND INITIAL ALL RULES &
REGULATIONS ON THE BACK OF THIS PAGE
Please Circle Appropriate Park:
FROM
Hilltop Park
TO
Acacia Park
Please Circle Appropriate Picnic Area(s) – maximum of two areas per site:
1
2
3
4
5
1
2
________
________
BOUNCE HOUSES ARE NOT PERMITTED AT THESE TWO (2) FACILITIES
* PLEASE NOTE: THE AQUATICS FACILITIES AT THESE LOCATIONS ARE OPEN ONLY JUNE THROUGH AUGUST *
** A SEPARATE RESERVATION REQUEST FORM (POOL USE REQUEST) MUST BE SUBMITTED FOR PERMITTED USE OF THE POOLS **
RESIDENT REPRESENTATIVE INFORMATION
DATE OF EVENT: _____________________________________
DAY OF WEEK: ____________________________
TYPE OF EVENT: ______________________________________
NUMBER OF PEOPLE ATTENDING: ________
NAME: _______________________________________________
RECREATION ID CARD #: _________________
ADDRESS: ___________________________________________________________________________________________
HOME PHONE: ______________________________
CELL PHONE: ___________________________________
“By signing this form I agree to abide by ALL rules and regulations set forth on the back of this form.
Furthermore, I understand that violations of said rules and regulations will result in loss of my Security Deposit.”
______________________________________________________
_____________________
Signature of Resident Representative
Date
FOR DEPARTMENT USE ONLY
Employee Taking Reservation:
Supervisor Approval:
Staff:
Approved
______________________________
❑
Denied ❑
By: ____________________________
Date & Time: ______________________________
____________________ @ _______ per hour = $_____________
Cancellation:
$50 Cancellation Fee applies?
_______________________ @ _______ per hour = $_____________
YES
NO
$10 Administrative Fee applies?
YES
NO
_______________________ @ _______ per hour = $_____________
Total Amount Due = $_____________
Staff/Date/Time: ___________________________
$200 Security Deposit:
Credit Card # __________________________________
Expiration Date: ____________
Staff/date: _____________________
PLEASE READ CAREFULLY & INITIAL ALL RULES & REGULATIONS:
1. _____ ALCOHOL IS NOT ALLOWED IN ANY CITY FACILITY OR PARK AT ANY TIME!
2. _____ A $200 Refundable Security Deposit is REQUIRED for all reservations by credit card number only.
Security Deposit MUST be received at time of reservation request but will not be charged to the card. If it
is deemed that a violation of these rules occurred or there is a late cancellation, your card will be charged
for the appropriate amount within 10 days of the reservation end date.
3. _____ You MUST clean your area, removing anything you brought into the Park. You will be held responsible
for any damage to or trash left on Park grounds or facility.
4. _____ You MUST have a current Recreation ID Card. Recreation ID Card MUST be presented when restroom
key is picked-up.
5. _____ Bouncers are NOT permitted at these two (2) facilities. Electricity is NOT available, so you will need a
generator for any electrical needs.
6. _____ You MUST be present at the event from beginning to end, as you accept responsibility for this reservation.
7. _____ Reservations can be made for a MAXIMUM of 50 people. No Exceptions! This will be monitored and
enforced.
8. _____ Residents may NOT reserve for Business Sponsored events. Violations may result in loss of Security
Deposit and all reservation privileges.
9. _____ NO vehicles may be driven in the Park at any time!
10. _____ Electricity is NOT available in the Park. You may NOT run extension cords into the Restroom Building
for any reason. Generators are allowed for groups that need power.
11. _____ Amplified sound (including Bands) is NOT allowed in the Park. If you wish to use amplified sound for
announcements, radios, etc…you MUST obtain a SOUND PERMIT from Planning & Building Safety at
City Hall.
12. _____ Restroom keys are available for check-out year round. Restroom keys are not needed: June – August
(during pool operating hours).
13. _____ The City of El Segundo reserves the right to cancel a reservation at any time and violation of any above
rule or regulation may result in loss of Security Deposit.
**Groups using a caterer MUST contact ESRP Staff at 310-524-2700 for catering rules & regulations!**