City of Clermont
Parks & Recreation Department
3700 S Hwy 27
Clermont, FL 34711
(352) 394-3500
www.clermontfl.gov
Clermont Arts & Recreation Center
Black Box Theatre
Rental Application
Page 1 of 7
City of Clermont
Arts & Recreation Center
Applicant Initials:
_______________
blackbox.2019
BLACK BOX THEATRE RENTAL APPLICATION
APPLICATION AND PAYMENT PROCESS
Applications will not be accepted less than 60 days, or more than 12 months in advance of a rental date following
confirmation of the CPAC season. Submitting an application does not guarantee confirmation of a rental date or room.
1. Submi
t a completed application to the Parks & Recreation Department located at the Arts & Recreation Center during
office hours, Monday through Friday between 8am-5pm, or by email to ARC@clermontfl.org
.
2. The application will be reviewed and the applicant will receive a cost estimate. A completed application, fees, and security
deposit must be submitted in full to reserve the room and are due at the time of reservation.
3. Payment can be submitted by cash, credit card, or check. Payment cannot be made over the phone or online.
4. The renter is responsible for all additional costs incurred during the rental, including but not limited to; use of equipment,
extended time in room, and building or technical staff. Until all outstanding balances are paid in full, the applicant or
organization will not be permitted to rent any city facility.
5. Changes to the approved application are only permitted by the applicant or alternate contact.
6. Applicant must be at least 18 years of age.
Today’s Date
Event Date
Name of Event
Name of Organization/Applicant
*The refundable deposit will be made payable and mailed to the name and address of the applicant listed*
City
State
Zip
Check if applicable:
Non-Profit
Tax Exempt
Non-Profit Documentation or Tax Exempt Certificate must be submitted with application.
Event Contact
Best Number to Reach You
Email
Valid Photo ID # Provided
Other
Secondary Contact
Best Number to Reach You
Email
ALCOHOL
Will there be alcohol at the event?
Yes*
No
*If yes, an alcohol approval form must be submitted a minimum of 30 days prior to your event.
Page 2 of 7
City of Clermont
Arts & Recreation Center
Applicant Initials:
_______________
blackbox.2019
EVENT DETAILS:
Estimated Attendance:
(maximum seating capacity 251)
What time is your event?
Start:
Finish:
What is your setup & exit time?
Begin Setup:
Exit Time:
Briefly Describe Your Event:
Check all that apply:
Private
Open to the Public
Meeting
Performance
Other
If other, please explain:
Admission Fee:
Yes
No
Check any Theatre Equipment needed
A/V Tech Required
No Tech Required Additional Equipment
Projector & Screen
Portable Projector
Podium
Advanced Lighting
Portable Projection Screen
Laptop
Microphone(s)
How many?
Wired Microphone & Portable Speaker
Preset Lighting
Other
Please explain:
*Renter must provide all cables, extension cords, etc
Please check any additional rooms needed:
Room
Time In
Time Out
Room
Time In
Time Out
Gymnasium
600 sq ft room
Clermont Room
300 sq ft room
Indicate any special requests or needs you may have:
Please list all groups that will be participating in your event:
Business Name:
Business Name:
Primary Contact:
Primary Contact:
Phone:
Phone:
Email:
Email:
Page 3 of 7
City of Clermont
Arts & Recreation Center
Applicant Initials:
_______________
blackbox.2019
FACILITY RENTAL POLICIES
Resident/Non-Profit:
Applicant is a resident or land owner located in the Clermont city limits
For-profit businesses may utilize the resident rate only if the business’s physical address is within the City limits. Rentals for the
intended use of a business function must utilize the business’s physical address.
*Non-Profit organizations must provide proof of non-profit status (501c3), and be currently registered and active with the Florida
Division of Corporations. Applicant must be a registered agent, representative, or board member of the organization/business.
Non-Resident/Business:
Applicant resides outside the Clermont city limits
Business is located outside the Clermont city limits
*Clermont Residents are not permitted to use ‘Resident’ status if the business is located outside of the city limits.
For-profit businesses, organizations, and individuals are prohibited to rent or utilize any City facility for business purposes
that would involve sales of any type. This would include, but is not limited to: charging admission, sales of products or
services, online sales, concessions, etc. (This does not include approved rentals of a performance nature)
Theatre Rentals
The Clermont Arts & Recreation Center is available from June through September, to for-profit businesses, organizations, and
i
ndividuals requesting to hold performances that are open to the general public.
Refer to the ‘Theatre Rental Application -Ticketed Event’ for information on ticket sales and concessions.
Registered non-profit organizations are permitted to hold events that are open to the general public throughout the year.
The Theatres are not available for rental by for profit organizations, individuals and/or businesses who wish to hol
d
per
formances that will be open to the general public during the City of Clermont’s performance season (September May).
*Open to the general public refers to any event or rental attended on a ‘walk-in’ basis, often without prior invitation. Generally,
these are publically advertised and may be either ticketed or non-ticketed, as well as free or paid events.
Event Publicity
No promotion, publicity, or advertising (printed or otherwise) may state, imply, or allude to any sponsorship by or affiliation with
t
he City of Clermont without prior written approval.
Scheduling of Room Rentals
Applications will not be accepted if they are incomplete or not signed.
Applicants are permitted to schedule a maximum of four (4) rental dates within a thirty (30) day period, with a maximum of thr
ee
(
3) rooms in the recreation wing per day. New applications will be accepted once the current rental agreement has expired.
Police and/or Fire Staff may be required based on the event’s program. The City of Clermont will determine the number of staf
f
r
equired and time needed. Officers are scheduled a minimum of four hours. This fee is paid by the renter.
Crowd Managers may be required depending on attendance.
The City of Clermont reserves the right to cancel any events/rentals in any City-owned facility or park.
Applicant Initials:
_______________
Page 4 of 7
City of Clermont
Arts & Recreation Center
Applicant Initials:
_______________
blackbox.2019
Rental Hours
Rentals during hours other than Monday to Saturday, 8:00 AM - 9:00 PM, and Sunday, 11:00 AM 6:00 PM, will require an
additional staffing fee at a two-hour minimum.
Rentals must vacate the building no later than 12:00 AM (7 days a week).
Rental times must include set up and break down.
It is the applicant’s responsibility to inform caterers or other participants of the event and contracted rental time.
Deliveries of rental equipment or other items must be made during the rental period. Caterers, vendors and event staff must
adhere to contracted rental time.
Setup Requirements:
All floor plans must be approved by the Facility Manager prior to the event date.
An exit checklist will be provided. It is the applicant’s responsibility to ensure all items are completed.
Loading and Unloading
At no time are vehicles permitted to be left unattended in the fire lanes, along sidewalks, or blacking pedestrian crosswalks.
Once unloaded, vehicles must be moved immediately.
LIABILITY INSURANCE
A Certificate of Insurance (COI) is required:
For any event or facility rental by a business or organization, both for-profit and non-profit
For any event or facility rental that is open to the general public
To serve alcohol in any city facility or property
A Certificate of Insurance (COI) may be required:
From a vendor that provides equipment (or similar items such as a tent, platform or stage, scissor lift, bounce house, etc.) to an
event or facility
Utilizing a generator or other potentially dangerous item
Under any other condition the City determines reasonable and necessary
The applicant shall supply, when required, a Certificate of Insurance reflecting minimum coverage of $1,000,000 Comprehensive
General Liability Insurance, without deductibles, per occurrence. The City of Clermont shall be named as an additional insured, which
shall be noted on the Certificate of Insurance as the Certificate Holder at City of Clermont, 3700 S Highway 27, Clermont, FL 34711.
The Certificate shall indicate that the applicant’s insurance policy shall not be cancelled without thirty days prior written notice to the
City of Clermont.
The COI must be submitted a minimum of 72 hours prior to the event date, listing the City of Clermont as additionally
insured. If the COI is not submitted as required, the city reserves the right to cancel the rental.
Applicant Initials:
_______________
Page 5 of 7
City of Clermont
Arts & Recreation Center
Applicant Initials:
_______________
blackbox.2019
SECURITY DEPOSITS, REFUNDS AND CANCELLATION POLICY
Security Deposits and Refunds
Deposits are held separate from the rental fees and are not applied toward account balances.
Security deposit refunds are issued 2-3 weeks after the rental date.
Cancellation Policy
ALCOHOL POLICY
The applicant is responsible for submitting a City of Clermont alcohol request form a minimum of 30 days prior to the rental
date (60 days is recommended).
Alcohol must be served by an approved licensed and insured organization, holding an appropriate State of Florida Alcohol,
Beverage and Tobacco License. Examples of those licenses include 13CT catering, or non-profit 1, 2, 3 day permit. Examples
of licenses not permitted include 2COP and 4COP licenses.
The serving of alcoholic must end at least 30 minutes prior to event end time.
The approved licensed and insured organization shall have general liability insurance with host liquor liability coverage
endorsement or event liability insurance which shall provide coverage in the event of an incident resulting from the serving of
alcohol beverages at the function. The City of Clermont shall be named as a co-insured in such policy. The minimum amount of
coverage shall be $1,000,000 aggregate per occurrence. The insurance shall be issued by a company acceptable to the City of
Clermont.
Not adhering to policy may result in forfeiture of your deposit and cancellation of your rental, and possible denial of future
requests.
The applicant is responsible for ensuring guests are adhering to the alcohol policy.
Rental Cancellation and Refund Policy
(application fees are non-refundable)
Cancellations must be submitted in writing
If you cancel within:
You will receive:
60 calendar days or more from the rental date 100% of the rental cost
59-31 calendar days from the rental date 50% of the rental cost
30 calendar days or less from the rental date No refund of the rental cost
Applicant Initials:
_______________
Page 6 of 7
City of Clermont
Arts & Recreation Center
Applicant Initials:
_______________
blackbox.2019
RENTAL RATES
Black Box Theatre includes:
- Stage, stage entrance room, and 251 fixed seats
- Adjustable lighting with preset controls
RENTAL RATE
3 hour minimum
RESIDENT &
NON-PROFIT
NON-RESIDENT
& BUSINESS
Per Hour Per Hour
$100 $125
ADDITIONAL ROOMS
RESIDENT &
NON-PROFIT
NON-RESIDENT
& BUSINESS
Per Hour
Per Hour
Clermont Room
1 hr minimum
$60
$70
600 sq ft room
1 hr minimum
$25
$30
300 sq ft room
1 hr minimum
$15
$20
Gymnasium*
2 hr minimum
$55
$75
*Full Court Rental includes use of up to 30 plastic chairs and up to 2 eight foot rectangular tables
Additional Equipment Per Item Additional Equipment Per Item
Projector & Screen
$75
Podium
$25
Laptop
$40
Portable Projector
$40
Microphone
$15
Portable Projection Screen
$20
Tables
Gymnasium only
$2
Wired Microphone & Portable Speaker
$55
Chairs
Gymnasium only
$1
Additional Staff
Per Hour
Facility Staff
2 hr minimum
$25
Crowd Managers
2 hr minimum
$25
Entertainment Tech
4 hr minimum
$25
Application Fee $10 Non-refundable
Security Deposit $200 Deposits are held separate from the rental fees and are not applied toward account balances
All fees and security deposit must be submitted in full to reserve the room and are due at the time of reservation.
Applicant Initials
I am requesting a technician for my rental.
I understand that it is my responsibility to schedule and discuss the technical requirements in advance of the
rental date. I also understand that the initial cost provided for technical assistance is an estimate, and may be
subject to change based on the requirements of the rental.
OR
I will not require a technician for my rental.
I understand that not all outside equipment, including laptops, may be compatible with the current audio/visual
system, and ARC staff will not be responsible for troubleshooting issues, providing additional cables, etc. to
correct problems that may occur the day of the rental. ARC staff may be contacted in advance of the rental date
to determine if outside equipment or media is compatible. (Technician rates may apply)
Page 7 of 7
City of Clermont
Arts & Recreation Center
Applicant Initials:
_______________
blackbox.2019
HOLD HARMLESS / INSURANCE AGREEMENT
The user will indemnify and hold harmless the City of Clermont from and against all claims, damages, losses, and expenses,
including reasonable attorney’s fees, arising out of, or resulting from the occupancy of the Park/Facility by the User, its
agents, servants, invitees, and guests under this license.
The User will comply with all laws, ordinances, regulations, or other orders regarding the safety of persons or property, or
their protection from damage, injury or loss.
The applicant shall supply, when required, a Certificate of Insurance reflecting minimum coverage $1,000,000
Comprehensive General Liability Insurance, without deductibles, per occurrence. The City of Clermont shall be named as
an additional insured, which shall be noted on the Certificate of Insurance. The Certificate shall indicate that the applicant’s
insurance policy shall not be cancelled without thirty days prior written notice to the City of Clermont.
The undersigned agrees to abide by the regulations governing the said facility and is responsible for charges incurred and
must supply the Certificate of Insurance to the City of Clermont no later than fourteen (14) calendar days prior to the
Program/Event Date. Also, the undersigned agrees to be responsible for damage to facilities and conduct of persons in the
program and/or event. Parking is permitted only in designated areas of the park/facility. There is no parking allowed at any
place of business or residence near the park/facility unless written permission is granted by each individual owner in advance.
I have read the rules and regulations and fully understand them. I accept responsibility and insure that all
members and guests will honor and abide by the above conditions.
Name of User (printed):
Group Representing:
User Signature
Date
City of Clermont Employee Signature
Date
v.1/1/17
GENERAL USAGE GUIDELINES
1. Signage/Advertising is permitted inside the rental room, and
nowhere else in the building or on the property.
2. Food and beverages may be brought in or delivered. It is not
permitted outside the rented room(s). The use of burning candles
or any other type of open flame is not allowed, with the exception
of sterno for chafing dishes. *Birthday candles are permitted*
3. Decorations are permitted inside the room, provided they are
free-standing and removed at the end of the rental. No
decorations shall be attached to walls, lights, doors or ceiling.
The use of tape, tacks, staples, nails, glue to walls, ceilings and
furniture.
4. Items not permitted are confetti or glitter; inside or outside. The
use/throwing of rice, flower petals, birdseed, confetti, glitter,
sparkles, dry ice, fog or smoke machines, sparklers,
pyrotechnics, or similar type items; inside or outside of the
facility.
5. Room use is limited only to the rooms specified in the rental
agreement. Only those listed on the application will be permitted
to make changes to the rental information Room changes will not
be permitted within 48 hours of the rental date.
6. Conduct Staff reserves the right to refuse admittance or to eject
any person causing harm or damage.
7. Pets are not allowed in the facility. Service dogs are welcome.
8. Tobacco use of any kind, is not permitted inside the facility
RENTAL DAY INFORMATION
1. Set up and Clean up time. Items cannot be brought into the
building before, or left after, the approved rental time. Vehicles
are not permitted to be parked in the fire lane. Items may be
unloaded onto the sidewalk, but vehicles must be moved
immediately after being unloaded.
*Vehicles may be towed at the owner’s expense
2. Trash must be properly disposed of by the renter in the trash
cans provided, or removed from the premises by the renter. Do
not leave any decorations, flyers, cardboard boxes, leftover food
or drinks, in the room. The applicant will be charged for additional
cleaning needed.
3.
Exit time. The room must be cleaned and vacated by the
scheduled departure time. The applicant will be charged in 30
minute increments for any guest or vendor that stays past the
permitted room time.
APPLICANT RESPONSIBILITIES
1. Rental Day. The applicant or secondary contact person must be
present for the entire duration of the rental.
2. Room times must be strictly adhered to. No one is permitted to
enter the room before the scheduled time. This includes vendors,
caterers, decorators, etc. If additional setup time is required, it
must be scheduled and paid for by the renter during normal
business hours.
3. Guests are not permitted to wander around the facility or in the
hallways, and children under 18 years old must be supervised by
an adult at all times.
4. Alcohol is not permitted anywhere on the property, unless prior
approval has been received. The applicant will be held responsible
for the conduct of all guests, and will forfeit the full security deposit
if alcohol is present at any time.
5. Music must be kept to an appropriate level so not to affect
adjacent rentals.
6. Room capacity must be adhered to at all times. The applicant
must monitor guest attendance throughout the rental period.
7. Staff may immediately cancel the rental if attendance exceeds
room capacity, with no refund of fees or deposit.
8. Cancellation of the rental may occur at any time if incorrect or
incomplete information is provided on the rental contract (i.e.,
contact information, resident status, nature of event, or
unauthorized use of alcohol). A refund of fees or deposit will not
be issued.
DAMAGES AND DEPOSITS
1. All damages, accidents, injuries, or malfunctioning
equipment must be reported to staff immediately.
2.
The applicant will be held liable for all damage that occurs to any
equipment, the room or the facility, inside or out, due to guest or
renter’s negligence. This cost will be deducted from the security
deposit. If the cost of damage/repair exceeds the security deposit,
the applicant will be billed for all additional costs (plus staffing
hours, if applicable).
VENDORS AND OUTSIDE BUSINESSES
All businesses providing services in the facility must provide an active
business tax receipt and liability insurance, naming the City of Clermont as
additionally insured. Failure to do so may result in loss of deposit.
Applicant Initials
Applicant Initials
Applicant Initials
Applicant Initials
Applicant Initials
Clermont Arts & Recreation Center
Facility Agreement and Guidelines
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