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Name of Agency or Organization Date of Application
Name of Person Making Request: ______Phone: ______
Address: ______City______Zip______Alt. Phone: ______
E-mail Address: ______
Are you a non-profit entity? YES NO EIN # ______
Facility/Equipment Requesting: Gymnasium Ball Diamond Field Area Other
If other, please specify: ______.
Brief description of planned activity: ______
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Number of anticipated participants: ______
Time facility is needed: From ______a.m./p.m. To ______a.m./p.m.
(Set-up and clean-up times need to be included in this request)
Day(s) facility is needed: Mon. Tue. Wed. Thur. Fri. Sat. Sun.
Date(s) facility is needed: ______
Applicant agrees to read and adhere to all provisions listed on reverse side of application ______
Applicant Signature
The Chief Executive Officer (CEO) must approve application
Request Granted Request Denied ______
Signature of CEO Date
RULES AND POLICIES
NO RENTAL AGREEMENT IS COMPLETE UNTIL ALL FEES HAVE BEEN RECEIVED. All fees shall be paid at the site of the rental 72 hours in advance of the scheduled activity date. If the activity is cancelled 72 hours to 24 hours before the scheduled time of use, 50% of the applicable fee will be forfeited. If the activity is cancelled less than 24 hours before the scheduled time of use, the applicable fee will be forfeited in full. Applicants must be at least 21 years old prior to renting our facility. Applicants must submit applications to the Chief Executive Officer two (2) weeks prior to the intended use. Applications will not be accepted more than six (6) months (or 160 days) before date of intended activity. Contracted rental times include set-up through clean-up times.
A deposit of $200.00 must be provided prior to facility rental. Deposit will be refunded should expectations defined in this agreement be met.
Boys & Girls Clubs of Topeka (BGCT) assumes no liability for the acts of the organization and/or persons utilizing the facility on the dates or during the times the facility is reserved for the benefit of such organizations/persons. The organization and/or persons hereby release and forever discharge and hold harmless the BGCT and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from such organization and/or persons activities at BGCT. The organization and/or person may have against the BGCT with respect to any bodily injury, personal injury, illness, death, or property damage that may result from the organization and/or persons activities at the BGCT, whether caused by the negligence of the BGCT or its officers, directors, employees, or agents or otherwise. The organization and/or persons also understand that the BGCT does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness.
Certificate of insurance must list BGCT as additional insured * please attach to Facility/Equipment Rental Request Form.
YESor NO (please circle)
In considering the request of any group to use our facilities, BGCT must take into account the nature of the proposed use of the facilities, the compatibility of the requests with the Club’s operation, the nature of the organization making the inquiry and the conditions under which the facilities are to be utilized.
Applicant agrees to comply with all applicable laws, rules, and regulations governing the use of the facilities.
Boys & Girls Clubs of Topeka is not responsible for providing equipment or services not requested.
By signing this application, the person making the request for facilities use thereby represents that he or she is authorized by the organization to make such request and that the organization agrees to be bound by the provisions set forth.
NOTE: No person shall drink or consume, or have in his/her possession in an open or closed container, any alcoholic liquor or cereal malt beverage on/in BGCT property.
Possession, use, sale or distribution of drugs, smoking in any of the facilities, and any acts deemed unlawful are strictly prohibited.
The Chief Executive Officer reserves the right to require security or additional staffing depending on the activity to be held which could result in additional fees. Final approval of all rentals will be with Chief Executive Officer’s discretion to include; safety, security, adequate seating, tables, equipment needed, activities that will be performed and the duration of the activities.
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I have read and agree to comply with all rules, rights, and regulations stated in the Facility/Equipment Rental Request Form.
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Signature of Applicant Date
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