Single Day Use. Exclusive Use of Facility (No other groups will be scheduled during your time) $1,200 per day _ Single Day Use—Non-Exclusive Use (Other Groups may be scheduled during your time) Please check all needed facilities below: Dining Hall (No Use of Kitchen) Multipurpose Shelter House Campfire Area Fishing Dock & Area (Lifejackets Required for all people on any docks) Other: Swimming Pool—Will you provide your own lifeguards? Canoes/Kayaks—Will you provide your own lifeguards? Low Ropes —Will you provide your own facilitators? High Ropes —Will you provide your own facilitators? Yes Yes Yes Yes No Time & Day: No Time & Day: No Time & Day: No Time & Day: As the person submitting this application for the group named above, I have read and agree to follow the attached Group Rental Guidelines and Rules. Furthermore, I assume responsibility for supervision of the group, its behavior, and any specialized recreation activities. I will provide orientation to the camp’s safety procedures and regulations as outlined in the attached Guidelines and Rules and the Rental Group Information Booklet. We understand that there are inherent risks involved in the use of this facility in an outdoor setting. We release the University of Kentucky, 4-H, its members, trustees, officers and employees from any liability for accidents or injury that any of our group may experience while renting the facility. Educational programs of Kentucky Cooperative Extension serve all people regardless of economic or social status and will not discriminate on the basis of race, color, ethnic origin, national origin, creed, religion, political belief, sex, sexual orientation, gender identity, gender expression, pregnancy, marital status, genetic information, age, veteran status, or physical or mental disability. Signing this rental form is indicative of your compliance with these regulations. Signature of Group Leader: Date: Signature of Supervising Agent (for Extension Sponsored Event) Date:
Single Day Use i. LPNs/MED SURG NURSES: Working twelve (12) hour shifts may use up to four (4) single use days of PTO for personal illness and/or personal need. These four (4) days are pro- rated for part-time nurses. Nurses may use four (4) additional single use days of PTO for personal need with approval from management if they replace themselves on a posted schedule without incurring overtime or premium pay. These four (4) days are pro-rated for part-time nurses.
