Application/contract donegal township/west alexander community center

APPLICATION/CONTRACT

DONEGAL TOWNSHIP/WEST ALEXANDER COMMUNITY CENTER

34 N. Liberty St., PO Box 310, West Alexander, PA 15376

Phone: [phone] Fax: [phone]

E-mail: [e-mail]

Date of Application:

Organization: Description:

Responsible Person:

Address:

Telephone: # of People Attending: PA System: Y N_

Date of Event: Time: to

Constable required? (determined by the board): Yes: No:

Name of Constable: Badge #:

Have you read and understood the Policy for the use of the facility? Yes: _ No:__ Init___

The applicant and individuals executing this application hereby waive any and all claims, demands and causes of action which they may have against Donegal Twp/West Alexander Community Center as a result of the use of the facility pursuant to this application. The applicant and individuals executing this application shall indemnify and hold harmless Donegal Twp/West Alexander Community Center and its officers and agents from and against any and all claims, demands, causes of action, and all other loss and expense, including reasonable costs of litigation arising out of or associated with the use of the Donegal Twp/West Alexander Community Center property by the applicant group and its members, guests, employees, and agents pursuant to this application.

I/we have read and agree to comply with the Policy and Regulations regarding the use of the Donegal Twp/West Alexander Community Center Facility.

Signature of Applicant/Responsible Party

OFFICE USE ONLY

Fees Due: Security/Clean-up Deposit: Rental Fees:

Paid: Paid: Total Paid: