Requested. Are you fully certified for the new subject/grade area? Yes No Not Certain Reason for Request (s): (The back of this sheet may also be used.) Approved Not approved Principal Signature: Date: Superintendent Signature: Date:
Requested. A unit member may request and arrange with the Superintendent a personal leave without pay.
Requested. □8:00am-12:30pm □12:30pm-5:00pm □5:00pm-9:30pm Room(s) Requested: □Sanctuary □Fellowship Area □Café & Kitchen □Fireside Area □Gallery □Adult Classrooms □Children’s Classrooms □Youth Classrooms □Pavilion / Parking Lot Anticipated Number of Participants Will a participant fee be charged? □Yes □No Will food or drink be consumed? □Yes □No Special Needs or Requests: 🞎 Pavilion use requires moving tables and chairs to the pavilion also requires cleaning and returning to their proper locations. □Custodial Cleanup ($50 per time segment) □Sanctuary Sound and or video System ($50 each per time segment) □Attachment to Sanctuary Sound System □Portable Sound System □TV’s or Projection Screens □Musical Instruments – specify Room Use Agreement Approval – Grace Baptist Church: □Approved event added to church calendar □Ministry Coordinator(s) notified of room(s) requested □Other – specify Trustee Signature Printed Name Date Worship Director Signature Printed Name Date Gallery Approval Signature Printed Name Date Release and Indemnity Agreement This agreement is between the above–named organization (“Organization”) and Grace Baptist Church.
Requested. A leave of absence which, at the time it is applied for and granted, is to be used in connection with a known or projected period of temporary disability (i.e. medical or physical inability to perform the employee's job) on the part of the employee. For example, a medical leave may be sought by an employee who is or will be temporarily unable to perform his job by reason of a disabling illness and/or injury, surgery, pregnancy and/or childbirth.
Requested. Day(s) of the Week: Event Hours: From: To: Public or Private: If Public, Ticketed or Free: Event Sponsor: Description of Event: *Alcohol Served: Yes No *Alcohol Use Agreement Required Approximate Attendance: Vendor(s): How many: Check All that Apply: Live Music/Dancing: Hours from to *Gambling: Hours from to Demonstrations: Hours from to **Amusement Rides etc.: Hours from to ***Liquor Sales : Hours from to ***Liquor Service: Hours from to ****Food Service: Hours from to Stage: Hours from to * State Gambling License Required **Dept. of Labor & Industries License Required ***State Liquor Control Board License/Permit Required ****Dept. of Health License Required FACILITY & RATE INFORMATION (Pioneer Pavilion Community Center) The newly-remodeled PPCC is approximately 6,000 square feet and restrooms are on premise. **At this time there are no kitchen facilities Community Event: Xxxx which applies Monday - Thursday: 4 hours or less $ 150.00 Monday - Thursday: All-day Event $ 500.00 Fri., Sat. & Sun 4 hours or less $ 250.00 Fri., Sat. & Sun All-day Event $ 600.00 Private Event: Monday-Thursday 4 hours or less $ 300.00 Monday-Thursday All-day Event $ 800.00 Fri., Sat. & Sun. 4 hours or less $ 400.00 Fri., Sat. & Sun. All-day Event $ 900.00 **Nonprofit Organization Even *Non-profit as defined by the IRS and event must be in Org. name. Monday - Thursday 4 hours or less $ 75.00 Monday - Thursday All-day Event $ 250.00 Fri., Sat. & Sun. 4 hours or less $ 125.00 Fri., Sat. & Sun. All-day Event $ 300.00 Early Decoration Cost: One - three hours (per hour): X $ 50.00 3+ hours must use full rental costs above Tables available: Seats
Requested product modifications will be implemented only upon mutual agreement. During the Initial Term of this Agreement, if new terms are not mutually agreed to within one hundred and eighty (180) days after the date the proposal of the new product design changes is made, the contracting parties agree to resolve any dispute about proposed or requested modifications of product design by arbitration pursuant to Article XIV of this Agreement. After the Initial Term, if new terms are not mutually agreed to within one hundred and eighty (180) days after the date any product design changes are proposed, this Agreement will terminate.
Requested. In accordance with the CBA, Article 4, Union Recognition and Employment, we are requesting the union: 🞸 Please provide priority referral of Disadvantaged Workers, based on zip code residence as described on the following page, or veteran status. 🞸🞸 Please provide priority referral of Targeted Workers, to the extent such status is known by the hiring hall or referral source; see list of criteria on the following page. WORKER REPORTING INSTRUCTIONS:
Requested. The facilities are to be used only on the date and hours agreed upon and for the purpose stated in this agreement. Hours as specified include set-up and cleanup. Should any personnel of The Delta Mill Society be required to stay past the hours specified on the permit, an additional fee will apply.
Requested. Title of Lecture Date & Time Location (please include address & phone number)
Requested. Set-Up Time: Start Time: End Time: Tear Down Complete: Set-Up Needs: Projector Mic Conference Call 6’ Tables (2) In consideration of being permitted the use of the space, the undersigned on behalf of the organization using the space, hereby fully discharges and agrees to indemnify The Community Foundation for XxXxxxx County (CFMC) for any and all known or unknown claims of liability that are asserted against CFMC arising from its use of the space. I have read and agree to the guidelines of the Facility Usage Agreement. User Signature Date Foundation Representative Date
