Fillable Community Use Form 20170126 (Montgomery College)

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Community Use Form 20170126 (Montgomery College)

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Event No.
COMMUNITY USE SPACE RESERVATION CONTRACT
Note: Request for Services MC Form 8.113b must accompany this contract if additional services/set up needed.
These forms must be submitted a minimum of (10) working days or earlier depending on the nature of the event, prior to the
scheduled event. Failure to do so will result in denial of request to use the facility and/or services will be denied. Payment of
rental fee required prior to event. Other charges will be billed after the event. Event may be cancelled due to weather or
other emergencies.
Name of Organization:
Space Reserved: Expected Attendance:
Date(s) of Event:
Hours Reserved: Hours of Event:
Name of Program:
(conference, meetings, athletic, etc.)
Will the event include participation of minors, defined as individuals under the age of 18 who are not enrolled at Montgomery
College?
❑
Yes
❑
N
o
If yes, user is responsible for complying with the Protection of Minors Policy and Procedure (75005CP), including contacting the
Youth Protection Coordinator at least 30 days prior to the event. Events that are not reviewed and approved may be prohibited
from operating.
Give complete details of event and name of speaker:
Name of Applicant:
Address:
Street City State Zip Code
Home/Cell Phone #: ( ) - Office Phone # ( ) -
Email:
I agree to be responsible for the group’s activity and conduct, to be present during hours of event. I acknowledge that
cancellation of an event requires five (5) working days to prevent assessment of fees. I have read and agreed to the Hold
Harmless Agreement on the reverse side of this form. I understand that use of the facilities does not constitute endorsement
of the activities by Montgomery College. I acknowledge receipt of “Rules and Regulations for Community Groups and
Organizations.”
(X)
Signature Sponsor/Civic Coordinator – PRINT NAME Date
MONTGOMERY COLLEGE
HOLD HARMLESS AGREEMENT
In signing the attached contract, the person representing the group or organization requesting use of Montgomery
Community College’s facilities certifies to the Board of Trustees of Montgomery Community College that he/she is the
authorized representative of the user group for whom the request is being made.
In signing the attached contract, the user group agrees as follows:
1. That the user group agrees that it will indemnify and hold harmless Montgomery Community College, its servants,
agents, and employees, and any students acting as such, from any and all liability, damage, expense, cause of
action, suits, claims, or judgment arising from injury to person or personal property or otherwise which arise out
of the act, failure to act, or negligence of the user group, its agents, members or invitees, in connection with or
arising out of the use of the facilities of Montgomery Community College.
2. That the user group will maintain, in good condition, any College property used in connection with the request and
that the property will be returned to the College in the same condition as when received. This includes filling in any
holes and reseeding or resodding any of the athletic fields, if required.
3. The user group agrees that it will abide by all applicable Executive Orders, Federal, State, and local laws, rules
and regulations.
4. The user group agrees that it will comply with all College rules and regulations regarding use of College facilities.
FACILITIES OFFICE USE ONLY
COMMENTS: Additional Approval Required? Yes No Date
Received
Request for Services attached? Yes
No
Insurance Certificate? Yes No
Campus Facilities Date
❑
Approved
❑
Denied
MC 8.113 (03/05) Distribution:
❑
Facilities
❑
Building Services
❑
O&M
❑
Other Services
❑
Security
❑
Requestor
❑
IT
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Community Use Form 20170126 (Montgomery College)

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Completed 18 July 2020

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