This form has been approved as to form and substance by the Attorney General’s office BRCC 5/88
Blue Ridge Community College
APPLICATION FOR USE OF CAMPUS FACILITIES
Please complete the application and submit it to the Office of the Vice President of Instruction and Student Services (Blue Ridge
Community College, P.O. Box 80, Weyers Cave, VA 24486) at least ten calendar days in advance.
1. Name of applicant: ______________________________________ Date of Application: ________________
2. Name of organization: _____________________________________________________________________
3. Itemized facilities required, special equipment, etc.: _____________________________________________
4. Activity Schedule:
Time of Activity:
Beginning/Ending
5. The undersigned hereby make(s) application to the Commonwealth of Virginia, Blue Ridge Community College, for the use of
the College facilities listed above. It is understood that the College makes no promise, representation, or warranty as to the
fitness or condition of the said facilities, notwithstanding anything to the contrary. The undersigned warrants that the applicant
will observe all rules and regulations of Blue Ridge Community College, and that the applicant will exercise the utmost care in
the use of the College’s premises and property, and will make good any loss or damage to said premises and property which
arises during or as a result of applicant’s use thereof, no matter what the cause. The user understands and agrees that it is
responsible for the acts/omissions of all of its participants or other using the premises as a result of the agreement.
6. The undersigned agrees to indemnify and hold harmless the Commonwealth of Virginia, Blue Ridge Community College, its
agents and employees, from any and all claims including injuries to persons and/or propriety arising, directly or indirectly, out of
such use. The undersigned further releases the Commonwealth of Virginia and the College, including its agents and employees,
from any damage to or loss of its property while on the College premises, no matter the cause.
7. The College reserves the right at all times to terminate use of the facility or to require user, or any participant with user, to leave
the College premises. This agreement is not assignable.
Applicant’s Signature: ______________________________ Street Address: ________________________________________
City: ___________________________ State: _____ Zip: ____________ Telephone Number: _______________
FOR OFFICE USE ONLY
Date Received: ______________________ Room Assignment: ____________________________________________
___Approved ___Disapproved Signature: ___________________________________________________
Distribution:
1. Applicant
2. Academic Deans’ Office
3. Audio-Visual
4. Buildings and Grounds
5. Counseling
6. Public Relations
7. Receptionist/Admissions and Records
8. Security
9. Workforce Services and Continuing Ed.
Copy: ________________________
________________________
Fees (if appropriate)
Custodial Services:
Security Services:
TOTAL:
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