Rental Application

Facility Rental Application# __________ 


Name of Applicant (must remain onsite during event): ________________________________

_______________________________________      __________________________________

Applicant's Address                                                      City/State/Zip

_______________________        _______________________        _______________________

Applicant's Daytime Phone             Cell Phone                                      Evening Phone


Applicant's Email Address


Name of Organization or Company: ______________________________________________

Non-Profit Tax ID: _____________________     Are you a youth organization?  Y/N (circle one)

Contact Person (must remain onsite during event): ___________________________________

_______________________________________      __________________________________

Organization Address                                                   City/State/Zip

__________________________           __________             ____________________________   

Organization Phone                                  Ext.                           Organization Email Address



____________________________________      __________________________________

Requested Date(s)                                                  Requested Day(s) of Week if Recurring Rental

Total Rental Hours: ____________________           Event Hours: ________________________

NOTE: Rental hours must include all time needed for decorating and set up, the “event”, and clean up.


FACILITY REQUESTED:     ____  Main Hall        ____ Kitchen       ____ Meeting Room



Type of Event: ________________________________________________________________

Maximum Attendance: __________________             Will there be minors at event?  __________

Frequency of Event (circle one)        One time               Daily          Weekly         Monthly

Please check all that apply:

______      Event open to public                             ______      Admission/donation charged

______      Food served                                         ______      Music to be played

______      Food sold (permit required?)                ______      Amplified music

______      Catered event                                       ______      DJ/Band

______      Alcohol served                                     ______      Security required?

______      Alcohol sold (permit required?)             ______      Insurance required?


All items below must be initialed prior to request being considered:

initial ______       I have read and understand the Insurance requirements described in the General Provisions document.

initial ______       I understand that a Hold Harmless Agreement is required.

initial ______       I have read the Rules and Regulations for the facility and agree to, and will abide, by those rules and regulations before, during and after the event.

initial ______       I understand that all balances of the total rental are due prior to my event.

initial ______       I understand that smoking and use of illegal substances are not permitted at any time in the facility, and I will be responsible for informing my guests of that policy.

initial ______       I understand that  licensed security guards may be required, in the event that the honoree is under 21 years of age and attendance is over 75, or the event is open to the public, or the event is private and attendance is over 150.

initial ______       I understand that a Certificate of Insurance is required for any event where alcohol is served or if there are more than 100 participants at the event.


_____________________________________          ________________________

(Signature of applicant)                                                 (Date)


(Print or type name)


Office Use Only:

Received from applicant:

_____  Completed Application                   _____     Deposit (Ck. No. ________)

_____  Hold Harmless Agreement              _____     Rental Fee (Ck. No. ______, Amt: ________)

_____  Certificate of Insurance                   _____     Proof of  licensed security guards, if required