Date Requested. Times Requested: Setup Time: Room(s) requested: Number of People Attending: List of Amenities Requested (ie. Kitchen, podium, etc.): Applicant Signature: Date: , 20 Staff Signature: Date: , 20 Make Check or Money Order payable to: “West Hanover Township”. Any check returned for insufficient funds or on which payment has been stopped will result in automatic cancellation of the Community Center Facilities Agreement and will be charged a $25 service fee. Please submit fees, completed Community Center Facilities Agreement, Floor plan, and Waiver to: West Hanover Parks & Recreation - 000 Xxxxxx Xxxxxx, Xxxxxxxxxx, XX. 00000. THIS SECTION TO BE COMPLETED BY PARKS & RECREATION STAFF Date Paid: Rental Fee + Amenities: Discount: Total: Security Deposit: Total Amount Due: Payment Information: Cash Credit Card Check # Payment Amount: Amount Due: (This amount due 30 days prior to rental) WEST HANOVER TOWNSHIP PARKS AND RECREATION RELEASE AND WAIVER OF ALL CLAIMS AGREEMENT REGARDING RISK OF INJURY AND RELEASE AND WAIVE OF ALL CLAIMS I hereby apply to the Township of West Hanover to rent and use the facility, or facilities as mention in the attached agreement, for a private and/or public function during the time frame of (date), (time) I understand that by renting this or these facilities I will expose myself and my guests to normal risks of injury or harm associated with nature, events, classes, meetings and activities. I agree that I am responsible for my own safety. I agree to abide by all rules and regulations in regards to the Community Center use. I agree that I am responsible for my guest’s safety to the point of producing a safe event or activity during the length of this contract. I hereby assume all risk and responsibility of damage to the property of the Township of West Hanover as it relates to my event and my use and/or misuse; and hold the Township of West Hanover, its agents and representatives harmless for any and all suits relating to the use of Township owned facilities. I hereby agree to protect, indemnify, save, keep, and hold harmless the Township of West Hanover, its elected and/or appointed officials, its agents, servants and employees, against and from any and all claims, causes of action or liability, loss, damage or expense, brought by me or on my behalf or by my guests or on their behalf, arising out of the use of the Township facilities and the activities conducted therein or thereon for which I have made application to the Township to use f...
Date Requested. Time Requested: open: close: No one will be allowed in the pool area until 6:00 pm. You are responsible for any and all clean up including but not limited to; garbage, decorations, tables etc. You must be cleaned up by the time that you agreed to in your pool use agreement. Approximate number of quest expected: RENTAL COSTS: $ 50.00/Hour Resident $ 75.00/Hour Non-Resident SECURITY DEPOSIT: $ 75.00 STAFF COSTS FOR POOL RENTALS STAFF REQUIREMENTS Number of Patrons Main Pool Only 50—200 200 and up Staff Required 6 Feature Staff Required Wading Pool w/ Main Pool Small Blue Slide Bowl Slide Wading Pool Only 4 Total # of Staff X $12.50/Hour X Number of Hours = Total Staff Cost: $ Fees should be paid with two separate checks for bookkeeping purposes. Deposit is due at the time of the booking. Rental payment is due no later than two weeks before the rental. Signature of Applicant/Date Agent, Genoa Township Park District/Date Office Use Only Date Deposit Received Amount Cash/Check # Date Rental Fee Received Cash/Check # Amount This is an agreement between the Genoa Township Park District and the “responsible party” for the use of the fa- cilities in Xxxxxxxxxxx Park, 000 Xxxx Xxxxxx Xxxxxx xx Xxxxx, Xx. We the aforementioned do hereby agree to the following terms and conditions as set forth by the Genoa Township Park District. These regulations are to be fol- lowed to assure their refund of the responsible party's deposit. Responsible Party: _
Date Requested. HOW REQUESTED: PHONE LETTER FAX OTHER
Examples of Date Requested in a sentence
Internal use only Approval request Date Reviewed ADDENDUM III LEAVE REQUEST FORM TO: Assistant Superintendent – Human Resources TODAY'S DATE: EMPLOYEE ID NO.: Date Requested: Day of Week: Substitute Needed: All Day: Partial Day: (List Times) Substitute Not Needed: Each full time non-administrative employee may use five (5) days (no more than three (3) days consecutively) of leave each year for emergencies or other urgent and compelling business which cannot be conducted during non-school hours or days.
APPENDIX A - SICK LEAVE BANK GUIDELINES AND FORMS WEST CENTRAL CUSD #235 REQUEST TO USE SICK BANK DAY Employee Name Date Requested Date(s) for use of Sick Leave Bank Phone number where you can be reached on the day prior to the beginning date(s) you would like to use Sick Bank days: In order to be eligible for use of a Sick Bank day, you must have used all of your personally accumulated sick leave, personal leave, vacation leave and be docked one (1) day of pay.
More Definitions of Date Requested
Date Requested. Hours Requested: Day of Week: Total Expected Attendance: Do you understand that Morton Park District Ordinance PROHIBITS the consumption or possession of alcohol at All Facilities? Yes ( ) No ( ) Will there be admission charged or merchandise sold? Yes ( ) No ( ) If yes, please explain how proceeds will be used: Absolutely NO FOOD, DRINKS, or GUM allowed on the FieldTurf or playground No METAL CLEATS allowed No Smoking No Alcohol The Person in Charge (making the rental) must be present at all times during the rental Soccer Field Rental Fees Morton Park District Programs & Affiliate Groups $0/hr. All other groups $100/hr. Tumbling Room Rental Fees Morton Park District Programs & Affiliate Groups $0/hr. All other groups $50/hr. Upstairs Meeting Room Rental Fees Morton Park District Programs & Affiliate Groups $0/hr. All other groups $25/hr. Hold Harmless Agreement In consideration of the Morton Park District, extending the use of it’s property and facilities, the undersigned hereby agree to indemnify and to hold and save harmless said Park District from any and all claims, causes of action, judgments and liabilities of any kind, whether for property or personal injury of whatsoever nature and kind, which might arise from the undersigned’s use of the property and facilities from to . Said indemnification shall be binding on the undersigned regardless of whether or not the injured party is a member of the organization designated below, the Morton Park District itself or any other person. We have read and will abide by the Morton Park District Recreation Center rental policies and agree to be responsible for any damage to Park District property caused by our group/organization and attest that the above information is true and correct. Signed: Title:
Date Requested. Day of Week: Type of Activity: Starting Field Time: am/pm TO Ending Field Time: am/pm Name of Applicant: Phone Number: Name of Organization: State Non-Profit ID# Designated Person In Charge on the Day of Event: Phone: Address: City: Zip: Cell Phone: Email: Below please write in attendance for each age group; attendance numbers need to be as accurate as possible. Children (ages 1-12) Teens (ages 13-20) Adults (ages 21-35) Adults (ages 35+) RENTAL AGREEMENT My signature certifies I have read and understood the Sports Field Rental Policy and Rental Agreement as set forth by the City of San Pablo governing the use of Public Fields. I take full responsibility for ensuring the use of this facility and areas by the organization/party I represent is in full adherence and compliance with these rules and regulations. I understand I assume full responsibility for any penalty fees assessed by the City of San Pablo for any violations of these rules and regulations governing the use of the above requested field. I am aware my Deposit is non-refundable if I cancel within 2-weeks of my reservation for any reason. I am also aware that by signing this contract, I take full responsibility for the behavior exhibited by my guests during my rental.
Date Requested. Facility/Shelter:
Date Requested. HOW REQUESTED: PHONE LETTER FAX OTHER (B) DESCRIPTION OF CORRECTIVE ACTION NEEDED: CORRECTIVE ACTION NEEDS TO BE COMPLETE BY (DATE):
Date Requested. Hours Requested:
Date Requested. Hours Requested: Day of Week: Total Expected Attendance: Is this group based within the Morton Park District? Yes ( ) No ( ) Do you understand that Morton Park District requires a separate, approved agreement for rentals that will involve consumption or possession of alcohol at The Barn at Bull Run? Yes ( ) No ( )
Date Requested. Hours Requested: Day of Week: Total Expected Attendance: This Organization is a: Civic ( ) Religious ( ) School ( ) Charity ( ) Service ( ) Commercial ( ) Private ( ) Other ( ) explain: Is this group based within the Morton Park District? Yes ( ) No ( ) If yes, approximately what percentage of the membership resides within the boundaries of the Morton Park District? Do you understand that Morton Park District Ordinance PROHIBITS the consumption or possession of alcohol at all parks? Yes ( ) No ( ) Will there be admission charged or merchandise sold? Yes ( ) No ( ) If yes, please explain how proceeds will be used: Resident Rental Fees (A refundable damage and clean-up deposit of $50.00 is required for ALL rentals. Depositors forfeit $25.00 of the deposit if rental is cancelled.) Morton Park District Programs & Affiliate Groups $0/hr. In-District Chartered Non-Profit Groups $40/hr. ($240 max.) In-District Private Parties $60/hr. ($360 max.) In-District Commercial Enterprises $75/hr. ($600 max.) Non-Resident Rental Fees Out-of-District Chartered Non-Profit Groups $55/hr. ($330 max.) Out-of-District Private Parties $90/hr. ($540 max.) Out-of-District Commercial Enterprises $100/hr. ($800 max.)