POLICE 1800 8
th
Avenue West Linn Oregon 97068
telephone: (503) 655-6214 fax: (503) 656-0319
CITY OF TREES, HILLS AND RIVERS ● WESTLINNOREGON.GOV
will cause for cancellation of future privileges and for legal action including all costs
incurred by the City for collection.
3. I have read, understand, and agree to comply with all the rules, regulations, policies,
and fee schedules, as set forth by the City of West Linn. I further attest that I will be
personally responsible for repair or damage to equipment, the facilities, and the
grounds or for replacement of stolen equipment.
WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT
I agree to be responsible for the conduct of our group in and about the facilities in use, for the
control of noise, group participants, litter and damage beyond ordinary wear and tear, which
may occur while we are occupying the premises. I further agree that use of the John Satter
Community Room shall be in accordance with Policies and Procedures, local ordinances, and all
valid laws of the State of Oregon. It is understood that I waive all claims and hold harmless the
City of West Linn, its officers, employees, volunteers, and agents against all claims, damages,
loss or expenses, including attorney’s fees, arising out of or resulting from the use of this
facility, unless the claim arises solely out of the City’s own negligence.
Applicant must initial all four statements:
______I am over 18 years of age.
______I agree to adhere to all policies set forth by the City.
______All information, to the best of my knowledge, provided on this form is truthful.
______I have read and understand the City of West Linn Police Department Policy and
Procedures for John Satter Community Room (JSCR).
Printed Name of Applicant: ______________________________________________________
Signed: ______________________________________ Date: ___________________________
After-hours Access Card deposit: $50.00
Cleaning Deposit: $50.00
Total: $100.00
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