Department of Parks and Recreation-Tables and Chairs Rental Application

Department of Parks and Recreation

Tables and Chair Rental Application
It is the policy of the of the Department of Parks and Recreation to loan tables and chairs to tribal members on an as needed basis. The following policies shall apply:

1. Requests shall be made to tribal members only.

2. All requests shall be made using this application form and submitted to the Executive Director of Parks and Recreation within 5 days of pick-up.

3. A maximum of 4 tables and 10 chairs may be checked out.

4. Tables and chairs shall be checked out for a period not to exceed 3 days.

5. Tables and chairs must be picked and returned by the requestor and signed out/in by authorized staff of the Department of Parks and Recreation and the requestor.

6. Upon check-in, any tables and/or chairs that are damaged shall result in the requestor being billed the following: Table replacement-$150.00. Chair replacement-$100.00.

7. Tables and chairs must be returned within the specified time period. If they are not returned, the requestor will be billed the following: Table replacement-$150.00. Chair replacement-$100.00.

8. Failure of the requestor to satisfy financial obligation (# 6 and #7) within 30 days authorizes a deduction from their annual per cap payment until paid.
Date of Request*

MonthDayYear
Date
CDIB Number*
Name*
Address*
Phone*

Area CodePhone Number
Alternate Phone

Area CodePhone Number
Number of table request
Number of chair request
Date of Pickup*

MonthDayYear
Date
Pickup Location*
I certify the information in this application is true and correct, that I am an enrolled tribal member, and that I will comply with the table and chair policies listed above. I further authorize the Cheyenne and Arapaho Tribes to withhold my annual per cap payment for the replacement or repair of damages to tables and chairs loaned to me as a result of this agreement.
Date*

MonthDayYear
Date
Should be Empty: