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Download the Fireplace Use Form

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					                                 Pavilion Fireplace Use Form
     Note: The use of the Pavilion must first be reserved with Charley Loray. He can be contacted at 585-389-2018.

                              Basic Contact Information (Contact Person)
        Name:
   Phone Number:
     Cell Number
       Address:
 Group Sponsoring:
  Affiliation to Naz:

                                                Event Information
         Date:
     Start Time:
      End Time:
   Est. # of People:

   Descr. of Event:

 Fuel/Wood Source:

Precautions


1. Fire Extinguisher is required to be immediately available. One will be provided by Campus Safety.
2. Wood fueled fires only.
3. Fires must be small, controlled, and completely contained within the fireplace.
4. At event conclusion, fire must be thoroughly doused with water and embers spread out.
5. Campus Safety reserves the right to revoke this permit is fireplace is misused.


Signature (Person Responsible for Event)
        Name:
      Signature:
         Date:



Campus Safety
      Issued By:
      Signature:
         Date:

* Last Updated on Sept 22, 2010 - Department of Campus Safety

				
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posted:10/17/2011
language:English
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