The Corporation of the Township of Wilmot hereby grants the above, hereafter known as the Licensee/Renter, permission to use the Facilities as outlined, on the dates and times listed above, subject to the Terms and Conditions of this Agreement contained herein and/or attached hereto all of which form part of this Agreement.

The undersigned has read and on behalf of the Licensee /Renter agrees to be bound by this Permit/License and the Terms and Conditions contained herein and attached hereto, and hereby warrants and represents that he/she executes this Permit/License on behalf of the Licensee/Renter and has sufficient power, authority and capacity to bind the Licensee with his/her signature.

Name of Licensee/Renter (Please Print):

Signature of Licensee/Renter:

Date:

Staff Authorization:

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