Facility Requested. Com. Center Gym (without use of kitchen) Com. Center Gym (with use of kitchen) Com. Center Room #2 Com. Center Room #3 Com. Center Room #6 Chamber of Commerce Shelter Large Pavilion (without use of kitchen) Large Pavilion (with use of kitchen) Small Pavilion (no kitchen) Soccer Field (north of cemetery) Ball Field (north) Ball Field (south) Xxxxxxxxxx Park Fitness Room Key Fob Start date Start time End date End time Purpose Facility Usage Requested By Name Address City, State, Zip Email Organization Driver license # Phone User Agreement The assigned security Code/Fob is your responsibility. DO NOT share this Code/Fob with anyone. You must use your Code/Fob to enter the building and you may also be required to use it to lock the building upon your departure. You may be held responsible for any unauthorized use or damage that may occur during the times the electronic system indicates the building was accessed by your Code/Fob, including your Code/Fob being deactivated. A person of at least 16 years of age must be present at all times and assumes responsibility for any damage during the time your Code/Fob is recorded in use. You may request that your Code/Fob be deactivated if you suspect that it has been comprised in any way. You may also deacti- vate your Code/Fob if suspicious activity or misuse of the facility is suspected at any time. The facility must be left as found, including returning all tables and chairs to where they were upon your arrival. Key Fob must be returned within 48 hours after your event. I acknowledge receipt of St. Germain Code of Ordinance, Chapter 17 – Community Parks & Buildings Usage I assume responsibility for the facility during the time the Electronic Security Code/Fob is assigned to me. Save completed form to your device, then send it as an email attachment to: xxxx.xxxxx@xxxxxxxxxxx.xxx Signature Date
Facility Requested. 2. Requester’s Name: Organization or Individual (first time users may be asked to provide financial references)
Facility Requested. (please Check) Hornet Stadium $1,500 Hornet Gym $ 600
Facility Requested. Field Track Locker Room (Home) Locker Room (Visitor) Stands Press Box Ticket Booth # Score Board Field Lights Restrooms Other PLEASE PRINT YOUR NAME AND ADDRESS FIRMLY AND NEATLY. IT WILL BE USED FOR MAILING THIS FORM. FORM WILL NOT BE PROCESSED WITHOUT A BILLING ADDRESS AND PHONE NUMBER. District Use Only Organization: Person Responsible: _ Billing Address: City, State and Zip: _ E-mail Address : _ Home Phone: ( ) Time and Dates: Work Phone: ( ) Cell Phone: ( )
Facility Requested. (Please Check) Football Stadium $2500.00 Gymnasium $800.00 Baseball Field $800.00 Softball Field $800.00 Golf cart service $300 Senior Citizen & Handicap ride from parking to field.
Facility Requested. (Please Check) Football Stadium $2500.00 ________ Golf cart service $300 ________ Senior Citizen & Handicap ride from parking to field. Gymnasium $800.00 ________ Baseball Field $800.00 ________ Softball Field $800.00 ________
Facility Requested. Com. Center Gym (without use of kitchen) Com. Center Gym (with use of kitchen) Com. Center Room #2 Com. Center Room #3 Com. Center Room #6 Chamber of Commerce Shelter Large Pavilion (without use of kitchen) Large Pavilion (with use of kitchen) Small Pavilion (no kitchen) Ball Field (north) Ball Field (south) Xxxxxxxxxx Park Key Fob (single use) Start date : am / pm End date : am / pm Purpose
Facility Requested. GHRC Main Gym GHRC Pool GHRC Splash Park Community Center Name of group or person renting facilities (“Renter”): Responsible Person (for payments and compliance): DL# Billing Address: City: St: Zip: Home Phone: Work Phone: Cell Phone: Contact Person (if different from above) : Phone: Date(s) of Rental (list each on additional page if necessary):
Facility Requested. □ High School □ Franklin Elementary □ Roosevelt Elementary □ Middle School □ Xxxxxxx Elementary □ Administration Building □ Grant School □ Xxxxx Elementary □ Xxxxx Xxxx Field SPACE REQUESTED EQUIPMENT □ School Grounds □ Cafeteria □ Tables (qty. = ) □ Microphone □ All-Purpose Room □ Gymnasium □ Chairs (qty. = ) □ Podium □ Auditorium □ Media Center □ Other (specify) □ Classroom (specify) □ Other (specify) PERSONNEL □ Head Custodian □ Electrician □ Stage Crew □ Custodian □ A.V. Operator If cafeteria personnel are needed, please make arrange with the High School Cafeteria Manager, x1650. Licensee agrees to:
