APPLICATION FOR USE OF SPECIFIC GROUNDS
APPLICATION FOR USE OF SPECIFIC GROUNDS AT LITTLE RIVER COMMUNITY COMPLEX, INC.
Please return this completed application along with funds to: Little River Community Complex
PO Box 126, Bahama, NC 27503 Attention: Treasurer
Date(s) and time use________________________________________ Start: ___________End: ________
Name of Event: _______________________________________________________________________
Type of Event_________________________________________________________________________
Address: ________________________________________________Phone: _______________________
E-mail: _____________________________________________ Cell Phone: _______________________
Specific Area of grounds you request to use: _________________________________________________
What equipment will you have on the grounds: _______________________________________________
Is food to be served for a fee? ______________
If yes has the appropriate Health Dept. permit been obtained? ____________________
Hold Harmless/ Indemnification
To the fullest extent permitted by law I agree to defend, pay on behalf of, indemnify, and hold harmless Little River Community Complex, Inc, its elected and appointed officials, employees and volunteers, and others working on behalf of Little River Community Complex against any and all claims, demands, suits, or loss, including all costs connected therewith, and for any damages which may be asserted, claimed, or recovered against or from Little River Community Complex, by reason of personal injury, including bodily injury or death and/or property damage, including loss of use thereof, which arises out of my use of the Little River Community Complex grounds.
I have read and agree to the above hold harmless/indemnification clause as well as the Grounds Use Rules and Procedures Policy and I understand that the grounds will be left in a clean and neat condition after use, and I agree to pay for any damage to the facility/grounds which may incur, as a result, of this scheduled function.
Signature of responsible Person(s) __________________________________________
_____________________________________ Date: __________________