S:\FORMS\Parks & Recreaon
Mark one: Private Party/Individual Non-commercial Senior cizen group Governmental agency
Educaonal program
Name of Organizaon/Applicant: ___________________________________________________________________
Mailing Address: _______________________________________________ City/Zip: ________________________
Phone (s): __________________________________________ Email: ____________________________________
Date (s) of Use: _____________________________________________ Time : _____________ to ______________
(Must include set-up & clean up me)
Esmated aendance: _____________ Type of Event __________________________________________________
Requested Facility:
Community Center (25192 E Broadway) Not to exceed 100 people (Includes use of full kitchen; 8-8’ banquet
tables; 4-4’ round tables; and chairs for indoor use only.
Rental Rates: Number in aendance Min. Charge (1st 3 hrs.) Each Add. Hour
1-10 People $35 $15
11-50 People $45 $20
51-100 People $55 $25
Deposit of $50.00 required for all rentals even if fee is waived or reduced. Deposit refundable if key is returned
and the Community Center is cleaned up as instructed in the Facilies Rental Rules and Agreements.
Events or group acvies sponsored by organized senior cizen groups will receive a 50% discount on above
rental fee.
Scheduled educaon programs may be scheduled on a 1 hour basis at the rate of $15.00/hour.
Non-prot organizaons may submit wrien requests to the City Council for fee reducons or fee waivers for
consideraon by City sta or City Council.
Failure to comply with Facilies Rental Rules & Agreements may aect connued and/or future waiver requests.
Events sponsored by the City of Veneta and/or other governmental agencies may use the Community Center at
no cost.
Fee reducons and waivers do not include the key/cleaning deposit.
I cerfy that I am the authorized representave of the above group( s), and that the above statements are true to the best of my
knowledge, and that myself and the organizaon I represent, agree to be bound by the rules and agreements regarding use of
the Cies facilies. I understand that violaon of any of these policies may jeopardize current and future use of the facility. I
have been given a copy of the rules and agreements and I and the organizaon I represent understand and agree to abide by
them in their enrety.
________________________________________________________ __________________________
Signature of Applicant Date
PO Box 458 * Veneta, OR 97487 * 541-935-2191 * Fax 541-935-1838 * www.venetaoregon.gov
Rental Fee $__________ Date Paid ___________
Receipt # ______________ Inials _______
Deposit $50/Date paid __________
Amount of Waiver Requested $______________________________
Council Waiver Approved □ Yes □ No
Date Approved/Denied _________/_________/___________
Key # ____
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