Facility Use Application

Filling out this form does not guarantee your reservation at the time or date requested!

Please read over our meeting room policies before submitting the form.

Important Notice:

Meeting room hours are listed below.

Monday-Sunday: 9:00 a.m. until 9:30 p.m.

Name of Group*

Is this group or organization a non-profit?*

Contact Person*

The contact person must be present in order for the room to be opened for the group. Additional group representatives may be listed under the "Other Authorized Individuals" section.

Phone Number*

Area CodePhone Number

Email*

example@example.com

Address

Street Address

Street Address Line 2

CityState

Postal / Zip Code

Other Authorized Individuals

These individuals will be allowed to open the room at the time of the meeting.

Facility Use Request*

Meeting RoomTraining FieldOther

Are you requesting*

Single dateRecurring dates

Reservation Date*

Date

Recurring dates requested

e.g. every other Wednesday or 10th of the month.

Reservation Time (including time for setup and cleanup)*

:HourMinutesAM/PM Option

Until

until :HourMinutesAM/PM Option

Number of Guests*

Brief Description of Meeting Agenda*

Please check any equipment your group may need.*

Projector/TV ScreenSpeakers/Sound SystemNo equipment needed

Do you expect any news media?*

YesNo

Any other special needs or notes?

The PARTICIPANT agrees that it will protect, save, defend, hold harmless, and indemnify KING COUNTY FPD #20, its employees, officers, and agents from any and all demands, claims, judgments, or liability for loss or damage arising as a result of accidents, injuries, or other occurrences, (except for losses or injuries occurring as the result of the sole negligence of KING COUNTY FPD #20), regardless of who the injured party may be.

For purposes of this agreement, the PARTICIPANT expressly waives its immunity under Title 51 of the Revised Code of Washington, the Industrial Insurance Act, for injuries to its employees and agrees that the obligations to indemnify, defend and hold harmless provided in this agreement extend to any claim brought by or on behalf of any employee of the PARTICIPANT. This waiver is mutually negotiated by the parties to this Agreement.

I AGREE*

YESNO

Signature*