Fillable CITY OF PROVIDENCE RECREATION CENTER FACILITY USAGE REQUEST (City of Providence)

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CITY OF PROVIDENCE RECREATION CENTER FACILITY USAGE REQUEST (City of Providence)

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Providence Recreation Department | 11 West Drive Providence, RI 02904 | 401-680-7300
CITY OF PROVIDENCE
RECREATION CENTER FACILITY USAGE REQUEST FORM
RECREATION CENTER:
Organization’s Information:
Name of Authorized Representative or Individual:
Address: City: Zip code:
Primary Phone Number: ( ) Secondary Phone Number: ( )
Email Address: Fax Number: ( )
Organization producing event is (please check one):
( ) Individual ( ) Commercial ( ) Non-Profit ( ) Non-Profit/501(c)3 tax exempt* ( ) Political
*Please provide copy of Non-Profit or 501(c)3 Tax Exempt Certificate & Copy of Insurance Certificate naming the
City of Providence as additionally insured for event/program.
Date(s) of Event/Program:
Start Time (including set up): AM/PM End Time (including breakdown): AM/PM
Type of Event: (check all that apply)
( ) Sports Program ( ) Religious Event ( ) Youth Program ( ) School Department Usage
( ) Birthday Party ( ) Re-pass ( ) Pool Usage ( ) Other________________
Location of Event:
( ) Gym ( ) Community Room ( ) Pool ( ) Grounds of the Recreation Center
Anticipated Number of Attendees:
( ) 1-100 People ( ) 101-200 People ( ) 201-300 People
Rental Policies:
• No rentals after 11PM.
• The official use of any Recreation Center and related facility must be with the expressed written consent
of the Providence Recreation Department.
• There is a mandatory $500 Damage Deposit Fee, which will be returned upon satisfactory inspection of
the rental property.
• Recreation Centers and related facilities are property of the City of Providence; the designated authorized
individual is responsible for compliance with all local, state and federal laws and regulations.
• Rental fee is $50/hour for all facilities, including set up and breakdown; all rental fees must be paid in full.
• The designated authorized individual is responsible for all damages incurred during rental.
Rental Cost: $50/hr. x hrs. = $ Money Order or Bank Check (circle one)
By signing this request form I acknowledge that I have read all of the policies above and understand that all
signatures must be obtained in order for the rental request to be approved.
Signature of authorized representative or individual:
Signature of Recreation Center Director:
Department Approval*: Date:
*Recreation Department approval is required to finalize rental.
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Providence Recreation Department | 11 West Drive Providence, RI 02904 | 401-680-7300
CIUDAD DE PROVIDENCE
FORMULARIO DE SOLICITUD PARA USO DE FACILIDADES
DEL CENTRO DE RECREACIÓN
CENTRO DE RECREACIÓN:
Información de la Organización:
Nombre del Representante Autorizado o Individuo:
Dirección: Ciudad: Código Postal:
Número Telefónico Primario: ( ) Número Telefónico Secundario: ( )
Correo Electrónico: Número de Fax: ( )
Organización produciendo evento es (favor de marcar una):
( ) Individuo ( ) Comercial ( ) Sin Fines de Lucro ( ) Sin Fines de Lucro/501(c)3 Exenta de Impuestos* ( ) Político
*Favor proporcionar una copia del Certificado de Sin Fines de Lucro o de 501 (c) 3 Exenta de Impuestos y una copia
del Certificado de Seguro nombrando la Ciudad de Providence como asegurado para el evento / programa.
Fecha(s) del Evento/Programa:
Hora de Inicio (incluyendo instalación): _AM/PM
Hora de Finalización (incluyendo desinstalación): _ AM/PM
Tipo de Evento: (marque toda que corresponda)
( ) Programa de Deportes ( ) Evento Religioso ( ) Programa de Jóvenes ( ) Uso del Departamento Escolar
( ) Fiesta de Cumpleaños ( ) Vigilia ( ) Uso de Piscina ( ) Otro____________________
Localidad del Evento:
( ) Gimnasio ( ) Sala de Comunidad ( ) Piscina ( ) Recinto del Centro de Recreación
Número de Asistentes Anticipado:
( ) 1-100 Personas ( ) 101-200 Personas ( ) 201-300 Personas
Pólizas de Alquiler:
• No se alquila después de las 11PM.
• El uso oficial de cualquier Centro de Recreación debe ser con el consentimiento expreso por escrito del
Departamento de Recreación de Providence.
• Hay una Fianza de Daños mandatoria de $500, que será devuelta después de la inspección satisfactoria de
la propiedad alquilada.
• Centros de Recreación son propiedad de la Ciudad de Providence; la persona autorizada designada es
responsable de cumplir con todas las leyes y regulaciones locales, estatales y federales.
• Precio de Alquilar es de $ 50 / hora para todas las facilidades, incluyendo instalación y desinstalación;
todos los gastos de renta deben ser pagados en su totalidad.
• La persona autorizada designada es responsable de todos los daños ocasionados en el tiempo de renta.
Precio de Alquilar: $50/hr x hrs = $ Money Order o Cheque Bancario (circule uno)
Al firmar este formulario de solicitud, confirmo que he leído todas las pólizas arriba y entiendo que todas las
firmas deben ser obtenidas para que la solicitud de alquiler sea aprobada.
Firma del Representante Autorizado o Individuo:
Firma del Director del Centro:
Aprobación del Departamento*: Fecha:
* Se requiere la aprobación del Departamento de Recreación para finalizar el alquiler.
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CITY OF PROVIDENCE RECREATION CENTER FACILITY USAGE REQUEST (City of Providence)

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Completed 24 February 2021

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