S:\FORMS\Parks & Recreaon
Mark one: □ Private Party/Individual □ Non-commercial □ Senior cizen group □ Governmental agency
□ Educaonal program
Name of Organizaon/Applicant: ___________________________________________________________________
Mailing Address: _______________________________________________ City/Zip: ________________________
Phone (s): __________________________________________ Email: ____________________________________
Date (s) of Use: _____________________________________________ Time : _____________ to ______________
(Must include set-up & clean up me)
Esmated aendance: _____________ Type of Event __________________________________________________
□ 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 aendance 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 Facilies Rental Rules and Agreements.
Events or group acvies sponsored by organized senior cizen groups will receive a 50% discount on above
Scheduled educaon programs may be scheduled on a 1 hour basis at the rate of $15.00/hour.
Non-prot organizaons may submit wrien requests to the City Council for fee reducons or fee waivers for
consideraon by City sta or City Council.
Failure to comply with Facilies Rental Rules & Agreements may aect connued and/or future waiver requests.
Events sponsored by the City of Veneta and/or other governmental agencies may use the Community Center at
Fee reducons and waivers do not include the key/cleaning deposit.
I cerfy that I am the authorized representave of the above group( s), and that the above statements are true to the best of my
knowledge, and that myself and the organizaon I represent, agree to be bound by the rules and agreements regarding use of
the Cies facilies. I understand that violaon 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 organizaon I represent understand and agree to abide by
them in their enrety.
Signature of Applicant Date
PO Box 458 * Veneta, OR 97487 * 541-935-2191 * Fax 541-935-1838 * www.venetaoregon.gov
FOR OFFICE USE ONLY
Rental Fee $__________ Date Paid ___________
Receipt # ______________ Inials _______
Deposit $50/Date paid __________
Amount of Waiver Requested $______________________________
Council Waiver Approved □ Yes □ No
Date Approved/Denied _________/_________/___________
Key # ____
click to sign
click to edit