Common use of Cancellation Policy Clause in Contracts

Cancellation Policy. In order to be refunded your deposit and usage fee, the lessee must notify the Parks and Lei- sure Department five (5) business days prior to the event. By signing the application below, I agree to abide by the following Terms and Conditions: In consideration for rental of the premises, I understand, and agree to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of deposit. I further understand that fundraising is not allowed on City property, and will not be using the facilities for that purpose unless I have written permission. I accept responsibility of use of the City of Auburn Ballfields on the date(s) and hours stated on this form Agreed to by: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD CK/MO# Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#

Cancellation Policy. In order to be refunded your deposit and usage fee, the lessee must notify the Parks and Lei- sure Department five (5) business days prior to the event. By signing the application below, I agree to abide by the following Terms and Conditions: In consideration for rental of the premises, I understand, and agree to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of deposit. I further understand that fundraising is not allowed on City property, and will not be using the facilities for that purpose unless I have written permission. I accept responsibility of use of the City of Auburn Ballfields on the date(s) and hours stated on this form Agreed to by: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO SMALL PAVILION RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED REQ’D A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Date: Date Payment Received: ______________ Liability Insurance YES NO Building passed inspection? YES NO Security Deposit Due: $50.00 Rental Approved By: ____________ CK#______ Date Approved: _________________ Return Security Deposit? YES NO Rental Amout Due: __$____________ Date of Rental: __________________ Deposit Returned: _________ Staff Initials:____ CASH CK/MO#______ Posted on Calendar Relay Date to Renter Customer survey returned? YES NO OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD CK/MO# RENTAL: Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO CASH CARD CK/MO# Date Approved: Return Security Deposit? YES NO Amount Remaining $ Date of Rental: Deposit Returned: Staff Initials: CASH CARD CK/MO#

Cancellation Policy. In order  If reservation is cancelled at least 2 weeks prior to event, a full refund will be issued.  If reservation is canceled less than 2 weeks from event date, but more than 24 hours, 50% of the rental fees will be refunded.  If reservation is cancelled less than 24 hours from event date, no refund will be issued. The rental applicant and/or sponsoring organization agrees to use the community building according to rules and regulations provided by the City of Fort Xxxxxx, its officials and employees harmless for any liability or any loss of property within the premises. Applicant also agrees to release the City of Fort Xxxxxx from any liability for the injury or death or any person arising from the utilization of said premises. The applicant agrees to be refunded your deposit legally responsible for the conduct and usage fee, the lessee must notify the Parks control of their guests/participants and Lei- sure Department five (5) business days prior to be financially responsible for any damages or injury incurred to the eventguests attending event held in the center. This is a contract. By signing the application below, I agree to abide by the following Terms and Conditions: In consideration for rental of the premises, I understand, you affirm that you have read and agree to follow the terms and comply with all above written guidelines which are incorporated herein by referenceconditions as stated. Failure to comply with these guidelines will result Applicant Name (Print) Applicant Signature Date POST RENTAL CHECK LIST Tables Wiped Down YES NO NOTES: Floors Swept (No Markings) YES NO NOTES: Bathrooms Tidy YES NO NOTES: Kitchen Wiped Clean YES NO NOTES: Sinks Empty and Clean YES NO NOTES: Oven & Stove Off and Clean YES NO NOTES: Ice Scoop in loss Place YES NO NOTES: Trashcans Emptied YES NO NOTES: No Food in Refrigerator YES NO NOTES: Beverage Containers Put Away YES NO NOTES: Hallway Free of privilege to use City facili- ties and will result in non return of deposit. I further understand that fundraising is not allowed on City property, and will not be using the facilities for that purpose unless I have written permission. I accept responsibility of use of the City of Auburn Ballfields on the date(s) and hours stated on this form Agreed to byDebris YES NO NOTES: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Belongings Removed YES NO NOTES: Decorations Removed YES NO NOTES: No Excess Trash By Dumpster YES NO NOTES: Time Checked Out: Staff Signature: Print NameRenter Signature: TitleITEMS DAMAGED: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD CK/MO# Rental Approved By: Date Approved: Date Photos of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#damages to be given to the Recreation Director.

Cancellation Policy. In order to be refunded your deposit and usage fee, the lessee must notify the Parks and Lei- sure Leisure Department five (5) business days prior to the event. By signing the application below, I agree to abide by the following Terms and Conditions: In consideration for rental of the premises, I understand, and agree to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties facilities and will result in non return of deposit. I further understand that fundraising is not allowed al- lowed on City property, and will not be using the facilities for that purpose unless I have written permissionpermis- sion. I accept responsibility of use of the City of Auburn Ballfields on the date(s) and hours stated on this form Agreed to by: LARGE PAVILION RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD CK/MO# Amount Remaining $ Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#

Cancellation Policy. In order If I fail to be refunded your deposit and usage fee, the lessee must notify the Parks and Lei- sure Department five (5) business days prior to the event. By signing the application belowcancel a scheduled appointment, I agree to abide by understand that Xxxx Xxxxx cannot use this time for another client who likely could have used the following Terms and Conditions: In consideration for rental of the premises, I understand, and agree to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of deposittime effectively. I further understand that fundraising there may be a $50 charge for each hour appointment slot that is either missed or cancelled with less than 24 hours notice (unless due to illness or family emergency). I understand this Counseling Agreement and Cancellation Policy covers me and any minor children I may include in counseling. Client Signature Date (Parent/Guardian signature if under age 18) Xxxx Xxxxx, M.A., LAPC, LAMFT xxx.xxxxxxxxxxxxxxxxxxxxxxxx.xxx xxxx@xxxxxxxxxxxxxxxxxxxxxxxx.xxx 000-000-0000 CURRENT FEE SCHEDULE PLEASE READ AND SIGN THE CURRENT FEE SCHEDULE PRIOR TO THE FIRST SESSION. IF THE CLIENT IS UNDER 18 YEARS OF AGE, THE AGREEMENT MUST BE SIGNED BY THE PARENT/GUARDIAN. Below is the current Restored Hearts fee schedule: 50-minute initial diagnostic interview $100.00 50-minute individual session 100.00 50-minute joint marital session 100.00 Court depositions/testimony per hour (door to door) 250.00 Missed sessions (or cancelled within 24 hours) 50.00 Sliding Fee schedule Restored Hearts offers a sliding fee scale based on income and the number of family members. If there is a financial hardship please don’t hesitate to ask about this. I would never want someone in need to not allowed on City propertyget help due to finances. If you believe your insurance company may reimburse you for your visits, and please mention this during our intake session. I will be happy to provide you with receipts to assist you in gaining reimbursement. Restored Hearts does not be using accept assignment; therefore, payment of all fees is the facilities for that purpose unless responsibility of the individual signed below at the time services are rendered. I have written permissionread the above fee schedule (including the 24-hour cancellation policy) and agree to its terms and conditions. By signing this agreement, I accept responsibility to pay these fees as services are rendered. I also understand I have the right to a copy of use this agreement upon request. Signature of the City Person Responsible for Payment Date Printed Name of Auburn Ballfields on the date(s) and hours stated on this form Agreed to by: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD CK/MO# Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#Above Individual

Cancellation Policy. Cancellations must be made before April 24th, as the Decatur Chamber of Commerce will be advertising the participating Food Trucks. In order executing this Agreement, Vendor acknowledges and represents that Vendor has read the foregoing Agreement including the foregoing Release of Liability and Indemnity agreement and will be bound by this Agreement. Name: _________________________________________________________________ Signature: ______________________________________________ Date:_______________ Decatur Chamber of Commerce EIGHTER FROM DECATUR FOOD TRUCK CHALLENGE Saturday, May 20, 2023 FOOD TRUCK VENDOR APPLICATION Please complete and return this form with all the items listed on last page. Name of Vendor (exactly how you wish it to be refunded your deposit listed): Contact Name: Contact Phone # Street Address or PO Box: City: State: Zip: Email Address: Truck Website: Truck Facebook: Twitter or other Social Media: TRUCK INFORMATION: Sales Tax Permit #:_ TAX ID#: Description of Food Served: Truck or Trailer: Total Est. Space Needed for Truck/Trailer: Actual Size of Vehicle: ft. Serve on Passenger or Driver Side: Est. Out of Window Time for Food: Max # of Meals Served at an Event: Length of that Event: Tag #of Trailer/Truck___________________________________________ Emergency Contact: (Someone not onsite for the event) Name:______________________________________________ Phone:_____________________________________________ GENERAL LIABILITY & VEHICLE INSURANCE: General Liability Provider: Policy #: General Aggregate Limit: Each Occurrence Limit: Vehicle Insurance Provider: Policy #: MENU OFFERINGS and usage fee, SIGNATURE DISH: Please indicate and describe the lessee signature dish that will be submitted for judging. Each truck must notify advertise to patrons the Parks and Lei- sure Department five (5) business days prior signature dish being presented to the judges. Signature Dish: Vendor Information & Checklist Thank you for your interest in the Decatur Chamber of Commerce 7th Annual Eighter From Decatur Food Truck Challenge Saturday, May 20, 2023 Grand Prize Food Truck Challenge is $5,000.00. Other prize amounts include: People's Choice $1000 Best Sweet Treat $1000 Sassy Savory Award $1000 Most Unique Food $1000 Best Bites $1000 Only one prize awarded per truck. Professional foodie judges select the winners for each category. Maximum number of trucks is 25. There is no fee to enter the contest, however it is limited to the first 25 trucks that enter. The Decatur Chamber of Commerce will reimburse vendors $2.00 per Eighter Taster Ticket. During the event, food is only sold by participating food trucks. By signing the application below, I agree Vendors are not allowed to abide sell beverages of any kind; all beverages are sold by the Decatur Chamber of Commerce. Applications will be reviewed on a first come, first-serve basis and acceptance begins on February 13th, 2023. Submittal/receipt of application does not signify acceptance; truck entries will be reviewed by a committee and vendors will receive notice via phone/email. The Decatur Chamber of Commerce reserves the right to refuse any application. (Only complete entries will be considered) Food Truck Challenge Hours 11am-2pm (after 2pm trucks can sell full menu items until 9pm) Completed Application Proof of Insurance W-9 Form Picture of truck to be used on social media Signature Dish Menu of items that will be served following Terms and Conditions: In consideration for rental of the premises, I understand, and agree challenge Please email completed applications to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of deposit. I further understand that fundraising is not allowed on City property, and will not be using the facilities for that purpose unless I have written permission. I accept responsibility of use of the City of Auburn Ballfields on the date(s) and hours stated on this form Agreed to by: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD CK/MO# Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#xxxx@xxxxxxxxx.xxx

Cancellation Policy. Reservations cancelled inside 10 days will forfeit deposit unless boats can be re- rented. A cancellation number will be issued at time of notification. Cancellation number: Deposit: Reservations require a deposit of $100.00 per Day per Boat Cancellation Policy Explained to Customer Reservation taken by Deposit Explained to Customer In order computer $50 Extra Fee to be refunded your deposit Remove Bimini Top Explaind Has Motel Room On calendar Deposit collected Date Rented: Number of people: Rental Fee: $100.00/Day/Boat Rental Deposit: $ Date: CONFIRMATION INFORMATION (10 Day Prior to Rental) Employee: DATE CONFIRMED: RENTAL FEES: Maximum of 10 people Left Message Date& Initials: Employee Initial: Full Day 7:00AM-5: 00PM $199.00 plus fuel and usage feetax Half Day * 7:00AM-12:00PM or 12:00PM-5:00 $125.00 plus fuel and tax *Half days are only available on the day of the rental when the boat has not been previously reserved* LESSEE TO READ ALL PAGES OF THIS AGREEMENT AND INITIAL EACH CLAUSE BEFORE SIGNING THIS DOCUMENT In consideration of the agreement herein, Sea Hag Marina (herein after referred to as the LESSOR) agrees to lease to the undersigned (herein after referred to as the LESSEE) the craft and equipment described herein. In the event the craft is not returned at time specified herein. Xxxx XXXXXX agrees to pay for OVERTIME at rate of $50.00 per each half-hour. Initial: THE LESSEE CERTIFIES THAT HE/SHE HAS EXAMINED THE CRAFT AND EQUIPMENT AND FINDS IT ACCEPTABLE AND SUITABLE FOR THE PURPOSE FOR WHICH IT IS LEASED. THAT HE/SHE WILL OPERATE THE CRAFT IN ACCORDANCE WITH ALL SAFETY RULES AND REGULATIONS AS POSTED IN THIS OFFICE OR ON THE CRAFT, AND FURTHER CERTIFIES THAT HE/SHE HAS READ AND UNDERSTANDS SAID RULES AND REGULATIONS. Initial: XXXXXX AGREES TO REPORT ANY ACCIDENT, MALFUNCTION OR BREAKDOWN OF RENTAL CRAFT TO LESSOR IMMEDIATELY IN ACCORDANCE WITH THE MALFUNCTION/BREAKDOWN CLAUSE WHICH FOLLOWS. Initial: This certifies that I (We), the lessee must notify the Parks LESSEE (S) am/are experienced and Lei- sure Department five (5) business days prior to the event. By signing the application below, I agree to abide by the following Terms and Conditions: In consideration for rental capable in all aspects of the premises, I understand, handling and agree to follow and comply with all above written guidelines which are incorporated herein by referenceoperation of the craft such as the one rented above. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of deposit. I further understand that fundraising is not allowed on City property, and XXXXXX agrees said craft will not be using occupied by a greater number of persons that is shown in this rental agreement. I, the facilities for that purpose unless I have written permission. I accept responsibility of use LESSEE (S) am/are aware of the City NO WAKE areas and am/are responsible for any damaged caused by my wake. I, the LESSEE (S) will not remove any equipment from Xxxxxx or Xxxxx County and will operate that said craft within a TWELVE mile limit from SEA HAG MARINA and I (We) have familiarized myself/ourselves with a chart of Auburn Ballfields on the date(s) and hours stated on this form Agreed to by: AUBURN CITIZENSarea. WATER SKIING, TOWING, AND/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OR NIGHT OPERATION OF RENTAL BOATS AND EQUIPMENT IS FORBIDDEN, NO EXCEPTION, LESSEE IS LIABLE. Initial: I authorize and allow SEA HAG MARINA to charge my credit card for any damages or loss of equipment. Boat rental price does not include refueling, oil or tax. Boat must be refueled at SEA HAG MARINA. Initial: The LESSEE acknowledges he/she has carefully examined the craft and finds it suitable for the purpose for which it is leased, and that or other accessory equipment is in suitable and acceptable condition: that he/she will maintain both craft and equipment in a safe, dependable condition while in he/she has custody. Initial: A major credit card authorization (VISA, MasterCard, Discover, American Express or Debit) or CASH CARD CK/MO# Rental Approved By: Date Approved: Date in the amount of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#five hundred dollars ($500.00) shall be retained by the LESSOR as partial compensation for failing to return said rental craft in as good condition, ordinary wear and tear excluded, as when received; for reimbursement of articles damaged, missing or broken; or to be applied to the rental charges upon return of craft by XXXXXX. XXXXXX agrees not to use, nor permit the use:

Cancellation Policy. In order If you fail to cancel a scheduled appointment, we cannot use this time for another client and you will be refunded billed for the entire cost of your deposit missed appointment. A full session fee is charged for missed appointments or cancellations with less than a 24-hour notice unless it is due to sudden illness or an emergency. This policy also applies to no shows for group appointments. Your credit card will be billed if you do not show up for, or cancel an appointment within 24 hrs of your scheduled appointment. Thank you for your consideration regarding this important matter. Client Signature (Client's Parent/Guardian if under 18):________________________ Date: ___/___/___ Credit Card Payment Authorization I,_____________________________, hereby authorize Xxxxxxxx Xxxxx Xxxxxxx, LCSW, PLLC to keep my credit card information and usage signature on file and to automatically charge my credit card account for: confirmation of initial evaluation appointments, appointments, missed/canceled appointments including the Initial Evaluation without 24 hour notice (will be charged at full fee), late fees (invoices past 30 days due), chargeback fees, and the lessee must notify the Parks and Lei- sure Department five (5full check(s) business days prior to the event. By signing the application below, I agree to abide amount that is/are not cleared by the following Terms and Conditions: In consideration for rental of the premises, I understand, and agree to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of deposit. I further understand that fundraising is not allowed on City propertybank plus a $30 returned check charge per incident, and will not be using dispute the facilities for that purpose unless I have written permissioncharges with my credit card company. I accept responsibility of use of the City of Auburn Ballfields This authority is to remain in full force and effect until Xxxxxxxx Xxxxx Xxxxxxx, LCSW, PLLC has received notification from me in writing in such time and in such manner as to afford Xxxxxxxx Xxxxx Xxxxxxx, LCSW, PLLC a reasonable opportunity to act on the date(sit. Client Name: ____________________________ Cardholder Name (as on card): Credit Card Number: ___________________________________________________ CVV Code (3 digits):_____________ Credit Card Type (please circle one): Visa / Master Card/ Discover/ Amex Expiration Date: _/_______/_______ Cardholder Billing Address (Street Number, Address, City, State, Zip Code) and hours stated on this form Agreed to by: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ _____________________________________ _____________________________________ Cardholder Phone Number: ______________________________ Cardholder’s Signature: Print Name: Title: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD CK/MO# Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#_________________________________

Cancellation Policy. In order to be refunded You must cancel or reschedule your deposit and usage fee, the lessee must notify the Parks and Lei- sure Department five (5) business days appointment a minimum of 24 hours prior to your scheduled time to avoid being responsible for the eventfull fee of that session. By signing Credit Card Information: Card Type (Circle One) Visa MasterCard Discover AMEX Card Number Exp. Date Security Code Billing Zip Code I understand that my credit card will be charged the application belowfull rate of my session, if I agree miss a scheduled appointment without giving 24 hours notice. Initial: If you have any questions or would like additional information, please feel free to abide by the following Terms and Conditions: In consideration for rental of the premises, I understand, and agree to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of depositask. I further understand that fundraising is not allowed on City property, have read this disclosure statement and will not be using the facilities for that purpose unless have discussed any questions I have written permissionhad regarding this content. I accept responsibility of use of the City of Auburn Ballfields on the date(s) and hours stated on this form Agreed am willing to by: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTALenter therapy under these conditions. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Printed Name: TitleSignature: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Acknowledgement of Review of Notice of Policies and Practices to Protect the Privacy of Your Health Information I have received a copy of this office’s Notice of Policies and Practices to Protect the Privacy of my Health Information, which explains how my health information will be used and disclosed and I have reviewed it. _________________________________________________________________ Signature of Patient or Personal Representative/ Guardian Print Name of Patient or Personal Representative/ Guardian ___________________________________________________________________ Description of Personal Representative/ Guardian’s Authority ____________________ Date Payment Received0000 Xxx Xxxxx Xx. Ste 601 Austin, TX 78746 PERSONAL INFORMATION Date Name Birthdate Email Address Home Telephone No. Cell Phone No. Home Address City State Zip Client Employed By Occupation Relationship Status: Security Deposit Due🞏 Married 🞏 Single 🞏 Cohabitant 🞏 Widowed 🞏 Divorced 🞏 Separated Name of Cohabitant/Spouse Spouse Employed By Occupation People Living in Your Home (with ages) Client Referred By… o Google o Psychology Today o Personal Reference: 50% OF RENTAL CASH CARD CKo Other: Person to Notify in Emergency Telephone No. Name of Physician Telephone No. 0000 Xxx Xxxxx Xxxx Xxx 000 Austin, TX 78746 SELF-­‐ASSESSMENT What is happening in your life that resulted in this appointment? What would you like to see accomplished in counseling? CHIEF COMPLAINT (check all that apply to you): ⭘ Depression ⭘ Low energy ⭘ Low self-­‐esteem ⭘ Poor concentration ⭘ Hopelessness ⭘ Worthlessness ⭘ Guilt ⭘ Sleep disturbance ⭘ Appetite disturbance ⭘ Thoughts of hurting yourself ⭘ Thoughts of hurting someone ⭘ Isolation/MO# Rental Approved By: Date Approved: Date social withdrawal ⭘ Sadness/loss ⭘ Stress ⭘ Anxiety/panic ⭘ Heart pounding/racing ⭘ Chest pain ⭘ Trembling/shaking ⭘ Sweating ⭘ Chills/hot flashes ⭘ Tingling/numbness ⭘ Fear of Rental: Building passed inspectiondying ⭘ Fear of going crazy ⭘ Nausea ⭘ Phobias ⭘ Obsessions/compulsive behaviors ⭘ Thoughts racing ⭘ Can’t hold onto an idea ⭘ Easily agitated/annoyed ⭘ Excessive behaviors (spending, gambling, etc.) ⭘ Delusions/hallucinations ⭘ Not thinking clearly/confusion ⭘ Feeling that you are not real ⭘ Feeling that things around you are not real ⭘ Lose track of time ⭘ Unpleasant thoughts won’t go away ⭘ Anger/frustration ⭘ Defying rules ⭘ Blaming others ⭘ Arguing ⭘ Excessive use of drugs and/or alcohol ⭘ Excessive use of prescription medications ⭘ Blackouts ⭘ Physical abuse issues ⭘ Sexual abuse issues ⭘ Spousal abuse issues ⭘ Other problems/symptoms Previous counseling? YES NO Return Security Deposit⭘ No ⭘ Yes If yes, with whom? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#What was accomplished? Medications (please list)

Cancellation Policy. In order to be refunded your deposit and usage fee, the lessee must notify the Parks and Lei- sure Department five (5) business days prior to the event. By signing the application below, I agree to abide by the following Terms and Conditions: In consideration for rental of the premises, I understand, and agree to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of deposit. I further understand that fundraising is not allowed on City property, and will not be using the facilities for that purpose unless I have written permission. I accept responsibility of use of the City of Auburn Ballfields on the date(s) and hours stated on this form Agreed to by: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO SMALL PAVILION RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A REQ’D AN ADDITIONAL 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Date: Date Payment Received: ______________ Liability Insurance YES NO Building passed inspection? YES NO Security Deposit Due: $50.00 Rental Approved By: ____________ CK#______ Date Approved: _________________ Return Security Deposit? YES NO Rental Amout Due: __$____________ Date of Rental: __________________ Deposit Returned: _________ Staff Initials:____ CASH CK/MO#______ Posted on Calendar Relay Date to Renter Customer survey returned? YES NO OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD CK/MO# RENTAL: Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO CASH CARD CK/MO# Date Approved: Return Security Deposit? YES NO Amount Remaining $ Date of Rental: Deposit Returned: Staff Initials: CASH CARD CK/MO#

Cancellation Policy. In order  If you wish to discontinue your services with MYL, you can email us at xxxxxxx@xxxxxxxxxxxxx.xxx or call us at 0000-0000-000 expressing the same and we will facilitate the closure of your account  You can cancel your account at any time, but you will remain liable for all charges accrued up to that time, including full monthly charges for the month which you discontinued service or any other charges as per the prevailing MYL policies at that time.  You will be refunded required to pay your bills within 7 days of account closure failing which your security deposit and usage fee, the lessee must notify the Parks and Lei- sure Department five (5) business days prior to the event. By signing the application below, I agree to abide by the following Terms and Conditions: In consideration for rental of the premises, I understand, and agree to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of deposit. I further understand that fundraising is not allowed on City property, and will not be refunded  Your security deposit amount (if any) will be refunded to you within 30 days of payment of accrued and pending charges. Privacy and Copyright Protection  MYL’s privacy policy explains how we treat your personal data and protect your privacy when you use our Services. By using our Services, you agree that MYL can use such data in accordance with our privacy policies.  MYL has right to use the facilities for your logo to be put up on our marketing brochures and websites unless a specific Non Disclosure Agreement is signed with you. Disclaimer of Warranties THE USE OF THE SERVICES SHALL BE AT YOUR OWN DISCRETION AND RISK AND YOU WILL BE SOLELY RESPONSIBLE FOR ANY DAMAGE ARISING OUT OF THE USE OF OUR SERVICES. MYL disclaims all warranties whether express or implied, including but not limited to (i) your ability to use the Service, (ii) your satisfaction with the Service, (iii) that purpose unless I have written permission. I accept responsibility of use the Service will be available at all times, uninterrupted, and error-free (iv), the accuracy of the City data provided by the Service, (v) Security and privacy of Auburn Ballfields on your data and (vi) that bugs or errors in the date(s) and hours stated on this form Agreed to by: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS Service will be corrected Limitation of Liability  YOU AGREE THAT MYL SHALL, IN NO EVENT, BE LIABLE FOR ANY CONSEQUENTIAL, INCIDENTAL, INDIRECT, SPECIAL, PUNITIVE, OR OTHER LOSS OR DAMAGE WHATSOEVER OR FOR LOSS OF BUSINESS PROFITS, BUSINESS INTERRUPTION, COMPUTER FAILURE, LOSS OF BUSINESS INFORMATION, OR OTHER LOSS ARISING OUT OF OR CAUSED BY YOUR USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF OR INABILITY TO USE THE SERVICE  YOUR SOLE AND EXCLUSIVE REMEDY FOR ANY DISPUTE WITH MYL RELATED TO ANY OF THE TOTAL RENTAL COST SERVICES SHALL BE TERMINATION OF SUCH SERVICE. IN NO EVENT SHALL MYL’S ENTIRE LIABILITY TO YOU IN RESPECT OF ANY SERVICE, WHETHER DIRECT OR INDIRECT, EXCEED THE FEES PAID BY YOU TOWARDS SUCH SERVICE  IF ANY PROVISION OF THE TERMS OF SERVICE IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% HELD INVALID OR OTHERWISE UNENFORCEABLE, THE ENFORCEABILITY OF RENTAL CASH CARD CK/MO# Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#THE REMAINING PROVISIONS SHALL NOT BE IMPAIRED THEREBY.

Cancellation Policy. In order to be refunded your deposit and usage fee, the lessee must notify the Parks and Lei- sure Leisure Department five (5) business days prior to the event. By signing the application below, I agree to abide by the following Terms and Conditions: RENTAL FEE $ ADDITIONAL HOURS + $ DEPOSIT DUE + $50 TOTAL DUE = $ In consideration for rental of the premises, I understand, and agree to follow and comply with all above written guidelines City policies which are incorporated herein by reference. Failure to comply with these guidelines policies will result in loss of privilege to use City facili- ties facilities and will result in non return of deposit. I further understand that fundraising is not allowed on City property, and will not be using the facilities faci lities for that purpose pur- pose unless I have written permission. I accept responsibility of use of the City of Auburn Ballfields X.X. Xxxxxxx Building on the date(s) and hours stated on this form Agreed to by: AUBURN CITIZENS/NON-PROFITS HRS PROFIT $30 (MONDAY-THURSDAY) NON-PROFIT $50 (FRIDAY-SUNDAY) ADDITIONAL HOURS Auburn Citizens/ Non-Profits X $10.00 12.50 = $ NONNon-CITIZENS HRS Citizens X $15.00 18.75 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD $50.00 CK/MO# Rental Amout Due: $ Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO Date Approved: Return Security Deposit? YES NO Amount Remaining $ Date of Rental: Deposit Returned: Staff Initials: CASH CARD CK/MO## Posted on Calendar Relay Date to Renter Customer survey returned? YES

Cancellation Policy. In order We do have a 24 hour cancellation policy. Our Rental Professionals will spend time on research, confirming availability, scheduling showings, preparing for the tour, etc. If you fail to give the Rental Professional at least 24 hours notice that you will need to reschedule or cancel your tour, we will require a $2001 cancellation fee for TOUR OPTION 1 and a $2501 cancellation fee for TOUR OPTION 2. THERE IS NO AGENCY RELATIONSHIP BETWEEN YOU AND THE RENTAL PROFESSIONAL CONDUCTING THE TOUR AND WORKING WITH YOU, OR BETWEEN YOU AND WPM SOUTH. The Rental Professional working with you, and WPM South, may be refunded your deposit and usage fee, the lessee must notify the Parks and Lei- sure Department five (5) business days prior to the event. By signing the application below, I agree to abide by the following Terms and Conditions: In consideration for rental or become agents on behalf of the premisesowners of properties that are part of the tour. A Rental Professional, I understandor WPM South, and agree to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of deposit. I further understand that fundraising is not allowed on City property, and will not be using become your agent except through a signed document identifying them as such. You are being provided with the facilities pamphlet entitled "The Law of Real Estate Agency", which you are encouraged to read before consulting with a Rental Professional or going on a tour. 1 This fee is for that purpose unless I have written permissionthe tour only and does not apply to application charges or any other rental expenses associated with leasing a home. I accept responsibility of use of the City of Auburn Ballfields on the date(s) and hours stated on this form Agreed to by: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL**Required fields APPLICANT INFORMATION Last Name** First Name** M.I. Social Security#** Driver’s License #** Birth Date** Home Phone Work Phone Cell Phone email EMERGENCY CONTACT 1. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name Address Phone Relationship 2. Name Address Phone Relationship Applicant Date W **Required fields APPLICANT INFORMATION Last Name: Title: ** First Name** M.I. Social Security#** Driver’s License #** Birth Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY ** Home Phone ork Phone Cell Phone email EMERGENCY CONTACT 1. Name Address Phone Relationship 2. Name Address Phone Relationship Applicant Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD CK/MO# Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO**Required fields APPLICANT INFORMATION Last Name** First Name** M.I. Social Security#** Driver’s License #** Birth Date** Home Phone Work Phone Cell Phone email EMERGENCY CONTACT 1. Name Address Phone Relationship 2. Name Address Phone Relationship Applicant Date

Cancellation Policy. In order to be refunded your deposit and usage fee, the lessee must notify the Parks and Lei- sure Leisure Department five (5) business days prior to the event. AUBURN CITIZENS/NON-PROFITS HRS X $20.00 = $ NON-CITIZENS HRS X $25.00 = $ LIGHTS $10.00 PER HOUR FOR USE OF LIGHTS HRS X $10.00 = $ FIELD PREP FOR GAME DRAG AND RELINE THE FIELD FIELD PREP FEE $25 CONCESSIONS VENDOR FEE CHARGED IF CONCESSIONS ARE POVIDED DURING RENTAL VENDOR FEE $100 DEPOSIT *SECURITY DEPOSIT REQUIRED* USE A SEPARATE CHECK FOR THE DESPOSIT (Only X checks accepted) By signing the application below, I agree to abide by the following Terms and Conditions: In consideration for rental of the premises, I understand, and agree to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties facilities and will result in non return of deposit. I further understand that fundraising is not allowed on City property, and will not be using the facilities faci lities for that purpose unless I have written permission. I accept responsibility of use of the City of Auburn Ballfields on the date(s) and hours stated on this form Agreed to by: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ DEPOSIT 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: RENTAL DUE $ DEPOSIT DUE $ *USE A SEPARATE CHECK FOR THE SECURITY DEPOSIT* TOTAL DUE $ Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD $ CK/MO# Rental Amout Due: $ Liability Insurance YES NO Facility passed inspection? YES NO Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit ReturnedReturn Date: Staff Initials: CASH CARD CK/MO## Posted on Calendar Relay Date to Renter Customer survey returned? YES

Cancellation Policy. Cancellations must be made before April 1st, as the Decatur Chamber of Commerce will be advertising the participating Food Trucks. In order executing this Agreement, Vendor acknowledges and represents that Vendor has read the foregoing Agreement including the foregoing Release of Liability and Indemnity agreement and will be bound by this Agreement. Name: Signature: Date: Decatur Chamber of Commerce EIGHTER FROM DECATUR FOOD TRUCK CHALLENGE Saturday, May 2nd, 2020 FOOD TRUCK VENDOR APPLICATION Please complete and return this form with all the items listed on last page. Name of Vendor (exactly how you wish it to be refunded listed): Contact Name: Contact Phone # Street Address or PO Box: City: State: Zip: Email Address: Truck Website: Truck Facebook: Twitter or other Social Media: TRUCK INFORMATION: Sales Tax Permit #:_ TAX ID#: Description of Food Served: Truck or Trailer: Total Est. Space Needed for Truck/Trailer: Actual Size of Vehicle: ft. Serve on Passenger or Driver Side: Est. Out of Window Time for Food: Max # of Meals Served at an Event: Length of that Event: DECATUR CHAMBER OF COMMERCE WILL PROVIDE GENERATORS FOR POWER. NO PERSONAL GENERATORS WILL BE ALLOWED PER CITY OF DECATUR FIRE XXXXXXXX. EACH TRUCK WILL BE RESPONSIBLE FOR PROVIDING HEAVY DUTY GROUNDED (IN GOOD CONDITION) ELECTRICAL CORD GENERAL LIABILITY & VEHICAL INSURANCE: General Liability Provider: Policy #: General Aggregate Limit: Each Occurrence Limit: Vehicle Insurance Provider: Policy #: MENU OFFERINGS and SIGNATURE DISH: Please indicate and describe the signature dish that will be submitted for judging. Each truck must advertise to patrons the signature dish being presented to the judges. Full menu items will only be allowed during the hours of 3:00 p.m. to 9:00 p.m. Signature Dish: Email: Xxxx@xxxxxxxxx.xxx or mail application to: Decatur Chamber of Commerce, PO Box 474, Decatur, TX. 76234 Power Supply Questionnaire Check the plug that fits your deposit and usage fee, unit: 50 AMP 30 AMP Truck Name: Plug location on your truck or trailer (Front or Back/ Driver or Passenger Side): Length of Power Supply Cord: We will ONLY be able to accommodate these two plugs for your truck or trailer on the lessee must notify the Parks and Lei- sure Department five (5) business days prior to day of the event. By signing Please make the application belowappropriate accommodations by providing an adapter on the day of the event. If you have questions, I agree concerns, or special requests please do not hesitate to abide call Xxxxx Xxxxxxx at 000-000-0000. We will to do our best to accommodate. Vendor Information & Checklist Thank you for your interest in the Decatur Chamber of Commerce 4th Annual Eighter From Decatur Food Truck Challenge held on Saturday, May 2nd, 2020. The event will be open to the public 10:30 am-9pm. The Grand Prize for the Eighter From Decatur Food Truck Challenge is $5,000.00. Other prize amounts include: People's Choice $500 Best Sweet Treat $500 Sassy Savory Award $500 Most Unique Food $500 Best Bites $500 • Only one prize awarded per truck. Professional foodie judges select the winners for each category. • Maximum number of trucks is 20. • There is no fee to enter the contest, however it is limited to the first 20 trucks that enter. • The Decatur Chamber of Commerce will reimburse vendors $1.00 per Eighter Taster Tester Ticket. During the event, food is only sold by participating food trucks. • Vendors are not allowed to sell beverages of any kind; all beverages are sold by the following Terms Decatur Chamber of Commerce. • Applications will be reviewed on a first come, first-serve basis and Conditions: In consideration for rental acceptance begins on February 1st, 2020. Submittal/receipt of application does not signify acceptance; truck entries will be reviewed by a committee and vendors will receive notice via phone/email. The Decatur Chamber of Commerce reserves the premises, I understand, and agree right to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of deposit. I further understand that fundraising is not allowed on City property, and will not be using the facilities for that purpose unless I have written permission. I accept responsibility of use of the City of Auburn Ballfields on the date(s) and hours stated on this form Agreed to by: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD CK/MO# Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#refuse any application.

Cancellation Policy. In order Cancellations to all extensions installation and maintenance services must be refunded your deposit and usage fee, the lessee must notify the Parks and Lei- sure Department five (5) business days made 48-hours prior to the eventdate of your appointment. Cancellations within less than 48-hours will result in a fee of 50% of the service quote for your appointment, as documented in your intake form. Initial the following: I have received a thorough consultation with my BELLAMI Certified Stylist. We have documented my hair's history, required professional maintenance, at-home care, any additional relevant information, and all of my questions and concerns have been resolved prior to this service. I am aware that the purchase of my BELLAMI Hair is NON-REFUNDABLE. I am aware that all BELLAMI Hair Extension application and maintenance services must be cancelled 48-hours prior to my scheduled service. Cancellations made within less than 48-hours will result in a fee of 50% of the service quote for your appointment. By signing the application belowand submitting this agreement, I 1) acknowledge that I have read and fully understand the terms of the agreement; 2) voluntarily agree to abide be bound by this agreement; and 3) certify that I am 18 years of age or older. My signature applies to all pages of this contract. Signature Page I declare that I am over the following Terms age of eighteen and Conditions: In consideration am competent to sign this consent and release of liability form, and I execute this document freely, knowingly and voluntarily. I hold Xxxxxx Xxxxxxxxx Salon + Spa and hair stylist(s) harmless from any damage, and injury I may have to any products, styling tools, or procedures used in the completion of this appointment. I release Xxxxxx Xxxxxxxxx Salon + Spa and its employees from liability for rental any damages or injuries that may be incurred to my extensions. Printed Name Signature Date Parent/Guardian Authorization - if applicable A parent or legal guardian must sign this agreement on behalf of any minor participant under the age of 18. By signing this agreement, I represent that I have the authority to sign and enter into this agreement on behalf of the premises, I understand, minor(s) listed above. Printed Name Signature Date Bellami Service Estimate **PLEASE ENTER ALL DETAILS FROM THIS SHEET INTO GUEST FORMULA NOTES IN SALONBIZ Extension Type: Weft K-Tip i-Tip Tape-In Hair Cost: Application: $ All hair pricing can be reviewed at xxx.xxxxxxxxxxxxxxxxxxx.xxx Maintenance Plan Follow-Up Frequency & Cost: per visit $ Every weeks / months Estimated TOTAL of Installation Visit: $ Additional details: Service pricing is estimated and agree subject to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of deposit. I further understand that fundraising is not allowed on City property, and will not be using the facilities for that purpose unless I have written permission. I accept responsibility of use of the City of Auburn Ballfields on the date(s) and hours stated on this form Agreed to by: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD CK/MO# Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#changes.

Cancellation Policy. No refund of deposit will be made if event is canceled within 14 days of event date. The Xxxxxx Historical Society & Museum is not liable in the event that the facility cannot be occupied on the reserved date due to vandalism, fire, act of nature, or any damage beyond the Museum’s control. In order the event of such an emergency, any money paid will be refunded. EVENT ACCESS 30 minutes of setup prior to the event is permitted with rental. Events must be refunded concluded, cleaned and all guests out of the facility 30 minutes after the scheduled conclusion time. If Xxxxxx doesn’t comply, an additional charge of $75 will be charged to the credit card on file for each extra hour the event is in session. IT IS IMPERATIVE THAT ALL PERSONS INVOLVED IN THE PREPARATION AND EXECUTION OF THE EVENT BE MADE AWARE OF THESE POLICIES, TERMS AND CONDITIONS. ANY DEVIATION FROM THESE POLICIES, TERMS, AND CONDITIONS WILL RESULT IN FORFEITURE OF DEPOSIT AND/OR FEES. Edmond Historical Society Gallery Rental Agreement Completion of this form, copy of current credit card, ID and payment of Half of Rental Fee are required to secure your event. The remaining half of the Rental Fee is due 14 days prior to your event. Your reservation is NOT valid until the EHS&M Events Coordinator has confirmed all of the required information has been received. Rates and services are subject to change. Rates are only guaranteed by signed contract. Renter’s Name:________________________________________________________________ Type of Event:_________________________________________________________________ Date of Event: ____________________________ Number of Attendees:_____________ Arrival Time: ___________ Event Start Time: ___________ Departure Time: ___________ Home Phone: ____________________________ Cell Phone___________________________ Home Address: ______________________________ City: _______________Zip:_________ E This is an agreement between the Xxxxxx Historical Society & Museum and _____________________. The event will happen as stated above and have a total cost of $______________, noting a deposit and usage fee, the lessee must notify the Parks and Lei- sure Department five (5) business of $________ received on ______________. The total balance of $______________ is due 14 days prior to the event. By signing the application belowPayment may be made in cash, check, or credit card. Make checks payable to EHS. mail Address:________________________________________________________________ YES, I agree to abide by the following Terms have received and Conditions: In consideration for rental of the premises, I understand, reviewed The Edmond History Museum event policy agreement and agree to follow all terms and comply with all above written guidelines which are incorporated herein by referenceconditions. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of deposit. I further understand that fundraising is not allowed on City propertyRenter’s Signature Date Xxxxxx History Museum Representative Date Edmond History Museum 000 X. Xxxxxxxxx, and will not be using the facilities for that purpose unless I have written permission. I accept responsibility of use of the City of Auburn Ballfields on the date(s) and hours stated on this form Agreed to byXxxxxx, XX 00000 Phone: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD CK/MO# Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#340.0078

Cancellation Policy. In order to Rental fees will be refunded your deposit if reservations are cancelled 24 hours or more in advance of the reservation date. The City will not issue a refund if cancelled within 24 hours of the reservation. Name of Organization: Telephone: Contact Person: Cell Number: Billing Address: Fax Number: City/State/Zip Code: E-mail: Date(s) of Meeting: No. of Attendees: Start Time: End Time: What is the primary purpose of the Organization/Group Meeting (please be specific): The undersigned agrees to the regulations listed on the back of this agreement and usage feehold harmless, defend and indemnify the lessee City of Forest Grove, its agents and elected officials, and all employees for any and all injuries, accidents, and attorney fees (if applicable), and will assume financial responsibility for any and all claims as a result of the use of the facility. I am authorized to execute this agreement on behalf of the above-named organization Signature of Authorized Individual or Representative Date ROOM RENTAL FEE $ City Staff Instructions: DEPOSIT, if applicable $ TOTAL AMOUNT DUE $ REVIEWED/APPROVED: Submit (signed) Agreement to: City of Forest Grove, Attn: Xxxx Xxxxxxx, City Recorder 0000 Xxxxxxx Xxxxxx, 0xx Xxxxx • P. O. Xxx 000, Xxxxxx Xxxxx, XX 00000-0000 Fax: 000.000.0000 • E-mail: xxxxxxxx@xxxxxxxxxxx-xx.xxx COMMUNITY AUDITORIUM RENTAL FEES (Effective July 1, 2017): Government & Non-Profit Group (per hour) Fee: $43.00 per hour minimum; $122.25 maximum For-Profit Group (per hour) Fee: $60.00 per hour minimum; $171.00 maximum Deposit Fee: $150.00 (refunded if no damage/cleanup) USER: Read and initial/checkmark acknowledging the regulations governing the use of the City Auditorium. Admission Fees/Announcement: Admission fee or payment for service may be charged to offset rental costs. No merchandise sales or contacts soliciting future business. No public publishing or announcement of the meeting may be made until auditorium reservation has been approved by the City. Smoking: Prohibited in accordance with ORS 192.710. Alcohol: Prohibited unless licensed for that purpose by the OLCC and approved by the Facility Manager. A copy of the approved OLCC permit must notify the Parks and Lei- sure Department be submitted within five (5) business days prior to the eventreservation date. By signing the application below, I agree to abide by the following Terms and ConditionsConduct: In consideration for rental of the premises, I understand, and agree to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines Loud or unruly behavior will result in loss the immediate forfeiture of privilege the rental. Food Service: Food and drinks may be served in the foyer area or outside courtyard. Plated food can be consumed inside the auditorium room. Setup and Cleanup (allow sufficient time): Return the Auditorium to use City facili- ties its original configuration (courtroom style; five (5) rolls, seven (7) chairs each roll, an isle in the middle); and please: • Wipe tables used; stack and store away extra chairs and tables; sweep/vacuum if necessary, including restrooms, kitchen, and foyer if these areas were used. • Empty trash receptacles and deposit into outside garbage bin; replace garbage liners (provided). • Remove all catering equipment and food; any other items belonging to the user. • Do not affix any adhesive material or push pins to walls or other surfaces. • Thermostat is temperature regulated and will result in non return of depositrun four (4) hours (press temporary occupied) and activate again if needed. I further understand that fundraising Configuration: In the event the facility is not allowed on City propertyleft in the same or similar condition as existing, including original configuration, at the time of use, the user will be held liable for a cleanup fee of $150. If cleanup or damage exceeds $150, the user is held liable for any additional costs. Meeting Areas: Meeting and/or activities are to be confined to the foyer, restroom, kitchen, and Auditorium. Conference rooms may not to be used by non-city users. Audiovisual (AV) Equipment: For AV presentation, bring own laptop and projector. There is a screen and dry erase board available at no cost. No audiovisual equipment is supplied by the City. The City’s equipment must not be tampered or system powered-on without permission or assistance by City staff. The user is held liable for damage and/or replacement cost of equipment used without permission. Guest Wi-Fi is available at no cost. IT City staff time may be assessed for any special assistance or accommodations made at the user’s request on the date of the meeting. Cancellation Notice: To cancel room reservation, notify the City Recorder, xxxxxxxx@xxxxxxxxxxx-xx.xxx 24 hours prior to the reservation date and/or as far in advance as possible. The City will not be using issue a refund for cancellation made with less than 24 hours. Certificate of Liability Insurance: Conditions and limits of this protection are as stated in the facilities for that purpose unless I have written permission. I accept responsibility of use of Oregon Tort Claims Act, ORS 30.260-300), naming the City of Auburn Ballfields on Forest Grove as an Additional Insurer, must be submitted within five (5) days prior to the date(s) and hours stated on this form Agreed to byreservation date. If no Certificate of Liability Insurance is received, the City will cancel the room reservation. Key/Alarm Access Code: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD CK/MO# Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#Pick up at City Hall, 1924 Xxxxxxx Xxxxxx, 0xx Xxxxx, 9:00am-4:45pm.

Cancellation Policy. In order the event that the undersigned wishes to cancel the ceremony or that the ceremony cannot take place through no fault of “Officiant”, the undersigned remains liable for the total amount agreed upon, as stated above. If the “Officiant” for some reason such as death, sickness, or accident beyond her control must cancel, “Officiant” will attempt to book another Officiant. If that is not possible all monies received will be returned to the Bride and Groom. Once signed below, no changes can be made in this agreement and it cannot be canceled. This agreement is therefore considered by all said parties to be refunded your legal and binding in accordance to the conditions set forth herein. Bride Signature: Groom Signature: _ Date Signed: $ Payment Date Paid Received by: $ Payment Date Paid Received by: Xxxxxx Xxxxx, Officiant Signature: Ceremony Services PAYABLE TO: Xxxxx Xxxxx 0000 X. Xxxxxxxxxx #208 Fresno, CA 93726 xxx.XxxxxXxxx.xxx ~ xxxxx@xxxxxxxxx.xxx ~ (000) 000-0000 Rental Agreement - Ceremony Only Rentals xxx.XxxxxXxxx.xxx Above Talk agrees to set-up and take-down all rental items. Items will be in place 30 minutes prior to ceremony, and taken down within 30 minutes following the scheduled ceremony. If take-down cannot begin within 30 minutes following the scheduled ceremony, there will be $20 per ¼ hour fee required. Rental Request:  $50 24 Chairs  $25 24 Chair Sashes  Black  Gold  Purple  Other: $15 For out of stock color  $75 Canopy/Arbor  $50 Heart Arbor COVERED  $25 Heart Arbor UNCOVERED  $25 (2) Pillar Flower Baskets, with white flowers & greenery Total for Rental Items: $ A deposit and usage feeof 50% is required to secure the rental date. Balance is due prior ceremony date. Ceremony Date: Ceremony Time: Ceremony Location: Cancellation Policy: In the event that the undersigned wishes to cancel the ceremony or that the ceremony cannot take place through no fault of Above Talk, the lessee undersigned remains liable for the total amount agreed upon, as stated above. If Above Talk for some reason such as death, sickness, or accident beyond their control must notify the Parks cancel, Above Talk will refund all monies received. Once signed below, no changes can be made in this agreement and Lei- sure Department five (5) business days prior it cannot be canceled. This agreement is therefore considered by all said parties to be legal and binding in accordance to the eventconditions set forth herein. By signing the application below, I agree to abide by the following Terms and Conditions: In consideration for rental of the premises, I understand, and agree to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of deposit. I further understand that fundraising is not allowed on City property, and will not be using the facilities for that purpose unless I have written permission. I accept responsibility of use of the City of Auburn Ballfields on the date(s) and hours stated $ Paid on this form Agreed to byDate: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ SignaturePaid on this Date: Print Name: TitleSign Name: DateContact Number: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment ReceivedLocation Number: Security Deposit DueAbove Talk Signature: 50% OF RENTAL CASH CARD CK/MO# Rental Approved ByRentals PAYABLE TO: Date Approved: Date of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MOXXXXX XXXXX 0000 X. Xxxxxxxxxx #208, Fresno, CA 93726

Cancellation Policy. Cancellations must be made before April 30thth, as the Decatur Chamber of Commerce will be advertising the participating Food Trucks. In order to be refunded your deposit executing this Agreement, Vendor acknowledges and usage fee, represents that Vendor has read the lessee must notify foregoing Agreement including the Parks foregoing Release of Liability and Lei- sure Department five (5) business days prior to the event. By signing the application below, I agree to abide by the following Terms and Conditions: In consideration for rental of the premises, I understand, and agree to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties Indemnity agreement and will result in non return of depositbe bound by this Agreement. I further understand that fundraising is not allowed on City property, and will not be using the facilities for that purpose unless I have written permission. I accept responsibility of use of the City of Auburn Ballfields on the date(s) and hours stated on this form Agreed to by: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: TitleSignature: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment ReceivedDecatur Chamber of Commerce EIGHTER FROM DECATUR FOOD TRUCK CHALLENGE Saturday, May 15th, 2021 FOOD TRUCK VENDOR APPLICATION Please complete and return this form with all the items listed on last page. Name of Vendor (exactly how you wish it to be listed): Contact Name: Security Deposit DueContact Phone # Street Address or PO Box: 50% OF RENTAL CASH CARD CKCity: State: Zip: Email Address: Truck Website: Truck Facebook: Twitter or other Social Media: TRUCK INFORMATION: Sales Tax Permit #:_ TAX ID#: Description of Food Served: Truck or Trailer: Total Est. Space Needed for Truck/MOTrailer: Actual Size of Vehicle: ft. Serve on Passenger or Driver Side: Est. Out of Window Time for Food: Max # Rental Approved Byof Meals Served at an Event: Date ApprovedLength of that Event: Date GENERAL LIABILITY & VEHICAL INSURANCE: General Liability Provider: Policy #: General Aggregate Limit: Each Occurrence Limit: Vehicle Insurance Provider: Policy #: MENU OFFERINGS and SIGNATURE DISH: Please indicate and describe the signature dish that will be submitted for judging. Each truck must advertise to patrons the signature dish being presented to the judges. Full menu items will only be allowed during the hours of Rental3:00 p.m. to 9:00 p.m. Signature Dish: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit ReturnedEmail: Staff InitialsXxxx@xxxxxxxxx.xxx or mail application to: CASH CARD CKDecatur Chamber of Commerce, PO Box 474, Decatur, TX. 76234 Vendor Information & Checklist Thank you for your interest in the Decatur Chamber of Commerce 5th Annual Eighter From Decatur Food Truck Challenge held on Saturday, May 15th, 2021. The event will be open to the public at 10:00 am- 9 pm. The Grand Prize for the Eighter From Decatur Food Truck Challenge is $5,000.00. Other prize amounts include: People's Choice $500 Best Sweet Treat $500 Sassy Savory Award $500 Most Unique Food $500 Best Bites $500 • Only one prize awarded per truck. Professional foodie judges select the winners for each category. • Maximum number of trucks is 25. • There is no fee to enter the contest, however it is limited to the first 25 trucks that enter. • The Decatur Chamber of Commerce will reimburse vendors $1.00 per Eighter Taster Tester Ticket. During the event, food is only sold by participating food trucks. • Vendors are not allowed to sell beverages of any kind; all beverages are sold by the Decatur Chamber of Commerce. • Applications will be reviewed on a first come, first-serve basis and acceptance begins on February 12th, 2020. Submittal/MO#receipt of application does not signify acceptance; truck entries will be reviewed by a committee and vendors will receive notice via phone/email. The Decatur Chamber of Commerce reserves the right to refuse any application.

Cancellation Policy. In order to be refunded your Reservations cancelled inside 10 days will forfeit the deposit and usage feemay be charged for the full rental for all days unless boats can be re-rented. For all other cancellations a cancellation fee of 20% of the deposit shall apply unless the deposit is held for a rescheduled date. A cancellation number will be issued at time of notification. Cancellation number: Deposit: Reservations require a deposit of $100.00 per Day per Boat Emp Initial Cancellation Policy Explained to Customer Deposit Explained to Customer Has Motel Room with Sea Hag Marina Reservation taken by YES_or_NORemove bimini, $50 if not requested at time of reservation. (Explain to customer) Date: Int: In computer DSN: On calendar Special notes:____________________ Date Rented: Number of people: Rental Fee: $100.00/Day/Boat Rental Deposit: $ Date: CONFIRMATION INFORMATION (10 Day Prior to Rental) Employee: DATE CONFIRMED: Left Message Date& Initials: Employee Initial: RENTAL FEES: Maximum of 10 people Full Day 7:00AM-5: 00PM $199.00 plus fuel and tax Half Day * 7:00AM-12:00PM or 12:00PM-5:00 $125.00 plus fuel and tax *Half days are only available on the day of the rental when the boat has not been previously reserved* LESSEE TO READ ALL PAGES OF THIS AGREEMENT AND INITIAL EACH CLAUSE BEFORE SIGNING THIS DOCUMENT In consideration of the agreement herein, Sea Hag Marina (herein after referred to as the LESSOR) agrees to lease to the undersigned (herein after referred to as the LESSEE) the craft and equipment described herein. In the event the craft is not returned at time specified herein. Xxxx XXXXXX agrees to pay for OVERTIME at rate of $50.00 per each half-hour. Initial: THE LESSEE CERTIFIES THAT HE/SHE HAS EXAMINED THE CRAFT AND EQUIPMENT AND FINDS IT ACCEPTABLE AND SUITABLE FOR THE PURPOSE FOR WHICH IT IS LEASED. THAT HE/SHE WILL OPERATE THE CRAFT IN ACCORDANCE WITH ALL SAFETY RULES AND REGULATIONS AS POSTED IN THIS OFFICE OR ON THE CRAFT, AND FURTHER CERTIFIES THAT HE/SHE HAS READ AND UNDERSTANDS SAID RULES AND REGULATIONS. Initial: XXXXXX AGREES TO REPORT ANY ACCIDENT, MALFUNCTION OR BREAKDOWN OF RENTAL CRAFT TO LESSOR IMMEDIATELY IN ACCORDANCE WITH THE MALFUNCTION/BREAKDOWN CLAUSE WHICH FOLLOWS. Initial: This certifies that I (We), the lessee must notify the Parks LESSEE (S) am/are experienced and Lei- sure Department five (5) business days prior to the event. By signing the application below, I agree to abide by the following Terms and Conditions: In consideration for rental capable in all aspects of the premises, I understand, handling and agree to follow and comply with all above written guidelines which are incorporated herein by referenceoperation of the craft such as the one rented above. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of deposit. I further understand that fundraising is not allowed on City property, and XXXXXX agrees said craft will not be using occupied by a greater number of persons that is shown in this rental agreement. I, the facilities for that purpose unless I have written permission. I accept responsibility of use LESSEE (S) am/are aware of the City NO WAKE areas and am/are responsible for any damaged caused by my wake. I, the LESSEE (S) will not remove any equipment from Xxxxxx or Dixie County and will operate that said craft within a TWELVE mile limit from SEA HAG MARINA and I (We) have familiarized myself/ourselves with a chart of Auburn Ballfields on the date(s) and hours stated on this form Agreed to by: AUBURN CITIZENSarea. WATER SKIING, TOWING, AND/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OR NIGHT OPERATION OF RENTAL BOATS AND EQUIPMENT IS FORBIDDEN, NO EXCEPTION, LESSEE IS LIABLE. Initial: I authorize and allow SEA HAG MARINA to charge my credit card for any damages or loss of equipment. Boat rental price does not include refueling, oil or tax. Boat must be refueled at SEA HAG MARINA. Initial: The LESSEE acknowledges he/she has carefully examined the craft and finds it suitable for the purpose for which it is leased, and that or other accessory equipment is in suitable and acceptable condition: that he/she will maintain both craft and equipment in a safe, dependable condition while in he/she has custody. Initial: A major credit card authorization (VISA, MasterCard, Discover, American Express or Debit) or CASH CARD CK/MO# Rental Approved By: Date Approved: Date in the amount of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#five hundred dollars ($500.00) shall be retained by the LESSOR as partial compensation for failing to return said rental craft in as good condition, ordinary wear and tear excluded, as when received; for reimbursement of articles damaged, missing or broken; or to be applied to the rental charges upon return of craft by LESSEE. XXXXXX agrees not to use, nor permit the use:

Cancellation Policy. In order The rental fee deposit is non-refundable. If a cancellation occurs: Within two (2) weeks of the event, your credit card will be charged with 25% of the food and beverage minimum. Within seven (7) days of the event, your credit card will be charged with 50% of the food and beverage minimum. For events in December, if a cancellation occurs: Within two (2) weeks of the event, your credit card will be charged with 50% of the food and beverage minimum. Within seven (7) days of the event, your credit card will be charged with 100% of the food and beverage minimum. The Bar stores a valid credit card on file, which will be charged under the terms above. Name on card: ________________________ Type of card: _________________________ Card number: _________________________ Expiration date: _______________________ Security Code: ________________________ I authorize Barrel Proof to be refunded your deposit and usage fee, charge the lessee must notify the Parks and Lei- sure Department five (5) business days prior credit card indicated in this authorization form according to the eventterms outlined in this Agreement. By signing I certify that I am an authorized user of the application belowcredit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form. Printed Name and Title Signature Date Liability Renter agrees to indemnify, I agree to abide by defend, and hold the following Terms Bar, its building owners, officers, and Conditions: In consideration for agents harmless of and from any liabilities, costs, penalties, or expenses arising out of and/or resulting from the rental and use of the premises, I understandincluding but not limited to, the personal guarantee of provision, service, and agree to follow and comply with all above written guidelines which are incorporated herein dispensing of payment by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of deposit. I further understand that fundraising is not allowed on City propertyRenter, its employees, and will not agents of alcoholic beverages at the Bar. In the event the Bar, its building owners, officers, and/or agents, are required to file any action in court in order to enforce any provisions of this agreement, Renter agrees to pay the Bar, its building owners, officers, and/or agents, all reasonable attorney fees, court fees, and costs of suit incurred by the Bar, including all collection expenses and interest due. Conduct The Bar reserves the right to refuse service to guests who conduct themselves in a disorderly manner, which shall be using determined in the facilities for that purpose unless I have written permission. I accept responsibility of use sole discretion of the City of Auburn Ballfields on the date(s) Bar. Acknowledged, Agreed and hours stated on this form Agreed to byAuthorized by Primary Contact/Renter: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Printed Name and Title _____________________________________________ Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Signature Acknowledged, Agreed and Authorized by Barrel Proof SF: Printed Name and Title _____________________________________________ Date: Signature Summary of Terms: Rental Deposit (Non-Refundable): ________________________Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD CK/MO# Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#_____________

Cancellation Policy. In order to be refunded your Reservations cancelled inside 10 days will forfeit the deposit and usage feemay be charged for the full rental for all days unless boats can be re-rented. For all other cancellations a cancellation fee of 20% of the deposit shall apply unless the deposit is held for a rescheduled date. A cancellation number will be issued at time of notification. Cancellation number: Deposit: Reservations require a deposit of $100.00 per Day per Boat Emp Initial Cancellation Policy Explained to Customer Deposit Explained to Customer Has Motel Room with Sea Hag Marina Reservation taken by YES_or_NORemove bimini, $50 if not requested at time of reservation. (Explain to customer) Date: Int: In computer DSN: On calendar Special notes:____________________ Date Rented: Number of people: Rental Fee: $100.00/Day/Boat Rental Deposit: $ Date: CONFIRMATION INFORMATION (10 Day Prior to Rental) Employee: DATE CONFIRMED: Left Message Date& Initials: Employee Initial: RENTAL FEES: Maximum of 10 people Full Day 7:00AM-5: 00PM $199.00 plus fuel and tax Half Day * 7:00AM-12:00PM or 12:00PM-5:00 $125.00 plus fuel and tax *Half days are only available on the day of the rental when the boat has not been previously reserved* LESSEE TO READ ALL PAGES OF THIS AGREEMENT AND INITIAL EACH CLAUSE BEFORE SIGNING THIS DOCUMENT In consideration of the agreement herein, Sea Hag Marina (herein after referred to as the LESSOR) agrees to lease to the undersigned (herein after referred to as the LESSEE) the craft and equipment described herein. In the event the craft is not returned at time specified herein. Xxxx XXXXXX agrees to pay for OVERTIME at rate of $50.00 per each half-hour. Initial: THE LESSEE CERTIFIES THAT HE/SHE HAS EXAMINED THE CRAFT AND EQUIPMENT AND FINDS IT ACCEPTABLE AND SUITABLE FOR THE PURPOSE FOR WHICH IT IS LEASED. THAT HE/SHE WILL OPERATE THE CRAFT IN ACCORDANCE WITH ALL SAFETY RULES AND REGULATIONS AS POSTED IN THIS OFFICE OR ON THE CRAFT, AND FURTHER CERTIFIES THAT HE/SHE HAS READ AND UNDERSTANDS SAID RULES AND REGULATIONS. Initial: XXXXXX AGREES TO REPORT ANY ACCIDENT, MALFUNCTION OR BREAKDOWN OF RENTAL CRAFT TO LESSOR IMMEDIATELY IN ACCORDANCE WITH THE MALFUNCTION/BREAKDOWN CLAUSE WHICH FOLLOWS. Initial: This certifies that I (We), the lessee must notify the Parks LESSEE (S) am/are experienced and Lei- sure Department five (5) business days prior to the event. By signing the application below, I agree to abide by the following Terms and Conditions: In consideration for rental capable in all aspects of the premises, I understand, handling and agree to follow and comply with all above written guidelines which are incorporated herein by referenceoperation of the craft such as the one rented above. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of deposit. I further understand that fundraising is not allowed on City property, and XXXXXX agrees said craft will not be using occupied by a greater number of persons that is shown in this rental agreement. I, the facilities for that purpose unless I have written permission. I accept responsibility of use LESSEE (S) am/are aware of the City NO WAKE areas and am/are responsible for any damaged caused by my wake. I, the LESSEE (S) will not remove any equipment from Xxxxxx or Xxxxx County and will operate that said craft within a TWELVE mile limit from SEA HAG MARINA and I (We) have familiarized myself/ourselves with a chart of Auburn Ballfields on the date(s) and hours stated on this form Agreed to by: AUBURN CITIZENSarea. WATER SKIING, TOWING, AND/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OR NIGHT OPERATION OF RENTAL BOATS AND EQUIPMENT IS FORBIDDEN, NO EXCEPTION, LESSEE IS LIABLE. Initial: I authorize and allow SEA HAG MARINA to charge my credit card for any damages or loss of equipment. Boat rental price does not include refueling, oil or tax. Boat must be refueled at SEA HAG MARINA. Initial: The LESSEE acknowledges he/she has carefully examined the craft and finds it suitable for the purpose for which it is leased, and that or other accessory equipment is in suitable and acceptable condition: that he/she will maintain both craft and equipment in a safe, dependable condition while in he/she has custody. Initial: A major credit card authorization (VISA, MasterCard, Discover, American Express or Debit) or CASH CARD CK/MO# Rental Approved By: Date Approved: Date in the amount of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#five hundred dollars ($500.00) shall be retained by the LESSOR as partial compensation for failing to return said rental craft in as good condition, ordinary wear and tear excluded, as when received; for reimbursement of articles damaged, missing or broken; or to be applied to the rental charges upon return of craft by LESSEE. XXXXXX agrees not to use, nor permit the use:

Cancellation Policy. In order to be refunded your deposit and usage fee, the lessee must notify the Parks and Lei- sure Department five (5) business days prior to the event. By signing the application below, I agree to abide by the following Terms and Conditions: In consideration for rental of the premises, I understand, and agree to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of deposit. I further understand that fundraising is not allowed on City property, and will not be using the facilities for that purpose unless I have written permission. I accept responsibility of use of the City of Auburn Ballfields on the date(s) and hours stated on this form Agreed to by: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A AN ADDITIONAL 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD CK/MO# Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#

Cancellation Policy. In order to be refunded your deposit and usage fee, the lessee must notify the Parks and Lei- sure Leisure Department five (5) business days prior to the event. By signing the application below, I agree to abide by the following Terms and Conditions: In consideration for rental of the premises, I understand, and agree to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties facilities and will result in non return of deposit. I further understand that fundraising is not allowed on City property, and will not be using the facilities faci lities for that purpose unless I have written permission. I accept responsibility of use of the City of Auburn Ballfields on the date(s) and hours stated on this form Agreed to by: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE DUE $ 50% DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD CK/MO# Rental Amout Due: $ Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO## Posted on Calendar Relay Date to Renter Customer survey returned? YES

Cancellation Policy. In order to be refunded You must cancel or reschedule your deposit and usage fee, the lessee must notify the Parks and Lei- sure Department five (5) business days appointment a minimum of 24 hours prior to your scheduled time to avoid being responsible for the eventfull fee of that session. By signing Credit Card Information: Card Type (Circle One) Visa MasterCard Discover AMEX Card Number Exp. Date Security Code Billing Zip Code I understand that my credit card will be charged the application belowfull rate of my session, if I agree miss a scheduled appointment without giving 24 hours notice. Initial: If you have any questions or would like additional information, please feel free to abide by the following Terms and Conditions: In consideration for rental of the premises, I understand, and agree to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of depositask. I further understand that fundraising is not allowed on City property, have read this disclosure statement and will not be using the facilities for that purpose unless have discussed any questions I have written permissionhad regarding this content. I accept responsibility of use of the City of Auburn Ballfields on the date(s) and hours stated on this form Agreed am willing to by: AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTALenter therapy under these conditions. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Printed Name: TitleSignature: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Acknowledgement of Review of Notice of Policies and Practices to Protect the Privacy of Your Health Information I have received a copy of this office’s Notice of Policies and Practices to Protect the Privacy of my Health Information, which explains how my health information will be used and disclosed and I have reviewed it. _________________________________________________________________ Signature of Patient or Personal Representative/ Guardian Print Name of Patient or Personal Representative/ Guardian ___________________________________________________________________ Description of Personal Representative/ Guardian’s Authority ____________________ Date Payment ReceivedXxxxx Xxxxxx, M.A., LPC 0000 Xxx Xxxxx Xx. Ste 601 Austin, TX 78746 PERSONAL INFORMATION Date Name Birthdate Email Address Home Telephone No. Cell Phone No. Home Address City State Zip Client Employed By Occupation Relationship Status: Security Deposit Dueo Married o Single o Cohabitant o Widowed o Divorced o Separated Name of Cohabitant/Spouse Spouse Employed By Occupation People Living in Your Home (with ages) Client Referred By… o Google o Psychology Today o Personal Reference: 50% OF RENTAL CASH CARD CKo Other: Person to Notify in Emergency Telephone No. Name of Physician Telephone No. Xxxxx Xxxxxx, M.A., LPC 0000 Xxx Xxxxx Xxxx Xxx 000 Austin, TX 78746 SELF-­‐ASSESSMENT What is happening in your life that resulted in this appointment? What would you like to see accomplished in counseling? CHIEF COMPLAINT (check all that apply to you): ¡ Depression ¡ Low energy ¡ Low self-­‐esteem ¡ Poor concentration ¡ Hopelessness ¡ Worthlessness ¡ Guilt ¡ Sleep disturbance ¡ Appetite disturbance ¡ Thoughts of hurting yourself ¡ Thoughts of hurting someone ¡ Isolation/MO# Rental Approved By: Date Approved: Date social withdrawal ¡ Sadness/loss ¡ Stress ¡ Anxiety/panic ¡ Heart pounding/racing ¡ Chest pain ¡ Trembling/shaking ¡ Sweating ¡ Chills/hot flashes ¡ Tingling/numbness ¡ Fear of Rental: Building passed inspectiondying ¡ Fear of going crazy ¡ Nausea ¡ Phobias ¡ Obsessions/compulsive behaviors ¡ Thoughts racing ¡ Can’t hold onto an idea ¡ Easily agitated/annoyed ¡ Excessive behaviors (spending, gambling, etc.) ¡ Delusions/hallucinations ¡ Not thinking clearly/confusion ¡ Feeling that you are not real ¡ Feeling that things around you are not real ¡ Lose track of time ¡ Unpleasant thoughts won’t go away ¡ Anger/frustration ¡ Defying rules ¡ Blaming others ¡ Arguing ¡ Excessive use of drugs and/or alcohol ¡ Excessive use of prescription medications ¡ Blackouts ¡ Physical abuse issues ¡ Sexual abuse issues ¡ Spousal abuse issues ¡ Other problems/symptoms Previous counseling? YES NO Return Security Deposit¡ No ¡ Yes If yes, with whom? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#What was accomplished? Medications (please list)

Cancellation Policy. In order to be refunded your deposit and usage fee, the lessee must notify the Parks and Lei- sure Leisure Department five (5) business days prior to the event. By signing the application below, I agree to abide by the following Terms and Conditions: In consideration for rental of the premises, I understand, and agree to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties facilities and will result in non return of deposit. I further understand that fundraising is not allowed al- lowed on City property, and will not be using the facilities for that purpose unless I have written permissionpermis- sion. I accept responsibility of use of the City of Auburn Ballfields on the date(s) and hours stated on this form Agreed to by: LARGE PAVILION RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A AN ADDITIONAL 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD CK/MO# Amount Remaining $ Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#

Cancellation Policy. In order to be refunded your deposit and usage feeFor any refund of fees, the lessee les- see must notify the Parks and Lei- sure Department five (5) business days prior to the eventLIC of cancellation in writing as early as possible. By signing the application below10 Conserve Energy: Our rustic log building is charming, I agree to abide by the following Terms and Conditions: In consideration for rental of the premises, I understand, and agree to follow and comply with all above written guidelines which are incorporated herein by reference. Failure to comply with these guidelines will result in loss of privilege to use City facili- ties and will result in non return of deposit. I further understand that fundraising but it is not allowed on City property, well-insulated. Conserve valuable and will not be using the facilities for that purpose unless I have written permissionexpensive heat by keeping doors closed during use. I accept responsibility of Excessive use of the City heat, water or electricity will be added to rental cost at sole discretion of Auburn Ballfields Rental Agent. EFFECTIVE JUNE 1, 2009 Accepted as lessee: DATE INITIALS Clubhouse 0000 Xxx Xxxxxxxxx Xxxxxxx Xxxxx (000)000-0000 Marina 0000 Xxx Xxxxxxxxx Xxxxxxx Xxxxx (000)000-0000 XX Xxx 000, Xxxxxxx XX 00000 xxx.xxxxxxxxxxxxxxxxxxxxxxxxx.xxx LIC Rental Rates Improvement Club B E T T E R I N G OU R C OM MU N I T Y S I N C E 1921 Longbranch Improvement Club Building Rental and Amenities Effective January 2015 Whole Building Rental Capacity 325 Includes ballroom, meeting room, grounds, tables, chairs and dry bar. Three day package Fri-Sat-Sun Sat-Sun-Mon or Thur-Fri-Sat $1,500.00 $ Day rate, 1-6 hours Fri, Sat or Sun 450.00 $ Mon-Tue-Wed-Thur 337.50 $ Day rate, 6-14 hours Fri-Sat-Sun 825.00 $ Mon-Tue-Wed-Thur 618.75 $ Meeting Room Rental Capacity 50 Includes tables and chairs. $35.00/hour $ Grounds Only Rental Does not include use of building or restrooms. Renter must supply porta-potties. $150.00/day $ Kitchen Rental includes stove lighting, dishes, flatware, coffee pots, coffee cups, pitchers, water glasses, refrigerator, freezer and microwave $150.00/day + $75.00 deposit $ Video Projector Rental includes 9-foot screen $100.00 + $35.00 deposit $ include this total on the date(s) Lease Agreement Tot al rental amount $ Complete and hours stated on attach this form Agreed sheet to by: AUBURN CITIZENS/NONLease Agreement. Renter accepts responsibility for replacement costs of broken, damaged or missing items and agrees to return items in clean condition in containers as delivered. DATE INITIALS Clubhouse 0000 Xxx Xxxxxxxxx Xxxxxxx Xxxxx (000)000-PROFITS HRS X $10.00 = $ NON-CITIZENS HRS X $15.00 = $ GAZEBO RENTAL FEE MINIMUM TWO HOURS OF USE PER DAY AUBURN CITIZENS/NON-PROFITS HRS X $5.00 = $ NON-CITIZENS HRS X $10.00 = $ 50% DEPOSIT REQUIRED A 50% DEPOSIT OF THE TOTAL RENTAL COST IS REQUIRED FOR ANY RENTAL. RENTAL FEE $ DEPOSIT DUE $ TOTAL DUE $ Signature: Print Name: Title: Date: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Payment Received: Security Deposit Due: 50% OF RENTAL CASH CARD CK/MO# Rental Approved By: Date Approved: Date of Rental: Building passed inspection? YES NO Return Security Deposit? YES NO Amount Remaining $ Deposit Returned: Staff Initials: CASH CARD CK/MO#0000