Community Center Rental Request Use this form to request the use of a community centerSECTION 1: General InformationName of Program/Activity*Name* First Last OrganizationEmail* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country SECTION 2: LocationRental Location*Truitt St. - GymnasiumTruitt St. - PatioTruitt St. - Multi-Purpose FieldAdditional Description of AreaSECTION 3: Activity InformationProgram Enrollment Fee*Please enter a value between 0 and 1000.Program DescriptionEvent Date* Start Time* : HH MM AMPM End Time* : HH MM AMPM Age Range of Participants*Please enter the minimum and maximum ages of participants in your program. Ex: "12 to 16"Anticipated Attendance*Do you intend to serve food?*NoYes - SnackYes - MealYes - Snack and MealSECTION 4: Fee ScheduleSECTION 4: Fee Schedule Rate Community Room $15/hr Kitchen $10/hr Resource Office $10/hr Gymnasium $30/hr Patio $10/hr Multi-Purpose Field $10/hr Supplies (as required) VARY Equipment VARY Security/Law Enforcement $55/hrSECTION 5: Rental Terms and ConditionsUse of Space The approved rental area shall be used only for the purposes specified in this agreement. The licensee agrees to use the area in such a manner so as to comply with all state, county, and municipal orders and regulations; and not to use the area or permit the same to be used for any disorderly or unlawful purposes. Failure to use the approved rental area in conformity with the purposes specified in this agreement will be considered a violation of this agreement. The City may terminate this agreement and immediately re-take possession of the area for any agreement violation. Additionally: • Under no circumstances should the licensee and/or group make any alterations, install equipment, or make attempts to maintain areas except for trash cleanup. All trash must be properly disposed of in receptacles provided for the purpose. The area should be returned to its normal condition except for normal wear. • The City reserves the right to refuse or cancel this agreement for any reasonable cause. Every attempt will be given to provide the organization adequate notice of cancellation. • Licensee shall not assign this license or any interest thereto to any other person or persons without the prior written consent of the City. • Should the rental area be damage or equipment damaged or stolen, the licensee and/or group will be assessed a repair or replacement fee. This fee must be paid within thirty (30) days or the City will begin collection proceedings and the licensee/group will be precluded from future rentals within the City until the past due amount is resolved. • The City reserves the right to restrict groups from providing alcoholic beverages on its premises. In all cases, when such requests are approved, it is the responsibility of the organization to adhere to the rules and regulations of the Wicomico County Liquor Board.Insurance RequirementsINSURANCE REQUIREMENTS If required, organization shall provide the City with Commercial liability insurance in an amount no less than One Million Dollars ($1,000,000) per occurrence and Two Million Dollars ($2,000,000) aggregate liability. The certificate shall be provided to the City on an annual basis and must name the City as Additional Insured and include the appropriate Additional Insured Endorsement(s).Payment Requirements• Rental fees must be paid to secure a reservation. • Additional charges may be incurred and the Licensee billed following the event if terms of the rental agreement change after initial payment is received by the City. A refund of event fees (minus non-refundable deposit) will be issued for any cancellation by the Licensee, provided notice of such cancellation is given not less than two weeks prior to the scheduled date of event. Overpayments will be refunded to the Licensee within 30 days of request. • Payment does not guarantee a reservation has been approved. • Cancellation Policy - Refunds in case of cancellation will be granted (minus non-refundable deposit), if requested 14 days prior to the desired date. All refunds are subject to a 10% service charge. Refunds may not be granted when a rental is cancelled due to inclement weather. In this case, another date may be scheduled based on availability. • Deposit - If the total due exceeds $100, a non-refundable deposit of $100 is required to secure the reservation. The remaining balance is due 14 days prior to the event.SECTION 6: Waiver and SignatureWAIVER: The licensee and/or group agrees to defend, indemnify, and hold harmless the City, its officers, agents, and employees from and against any and all claims, demands, causes of action, and liability of any kind for, and by reason of any act or omission of said licensee and/or group. Additionally, the licensee further accepts the rental area “AS IS” and releases, discharges and waives the City from any and all rights of action, either legal or equitable, which he has or ever may have against the City by reason of use of the said rental area, excepting only any such injury or damage resulting from the willful acts of the City.I am familiar with and agree to all policies which regulate the use of the rental area and have made the participating members of our group familiar with the same. I accept responsibility on behalf of the group for the activity described in this agreement.Electronic Signature*Fill in your name hereI understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance. I AGREE Get insurance for your company event HERE.