Application for Use of District Facilities
A $20.00 Non-Refundable Application Fee is Applied
Applicant
*
Title
Organization/Company (if applicable)
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Telephone
*
-
Area Code
Phone Number
Contact E-Mail
*
example@example.com
Facility Requested
*
Classroom
Lecture Hall
Gymnasium
Meeting Room
Other
Main Contact
Name
*
Title
*
Email
*
Phone
*
Fax
Attachments regarding your company's services may be included with your form submission.
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Cancel
of
Description of Activity
*
Actual Event Time
*
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12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Until
until
1
2
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9
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12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Date
-
Month
-
Day
Year
Date
Date Range:
*
Set-Up
*
1
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10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Clean-Up
*
1
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11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Size of Group
*
Nature of Group
*
Adults
Children
Open to the Public?
*
Will there be cash transactions during the event? If yes, please provide estimated cash proceeds:
*
NOTE: FOOD AND DRINK SALES ARE PROVIDED SOLELY BY THE DISTRICT
Will refreshments/food be served? If yes, describe:
*
Are you interested in District provided concessions?
*
Equipment Requested & Set-Up of Facilities
(Include number of all pertinent items)
Chairs:
*
Tables:
*
Lectern:
*
Screen/Monitor:
*
Data Projector:
*
Other:
*
Set-Up of Facilities? If yes, please upload a detailed diagram of requested set-up to application:
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of
Special Arrangements/Services Requested:
Insurance Requirements: Sponsor is required to provide a Certificate of Insurance showing evidence of insurance prior to authorization for facility usage. Sponsor's insurance must be written by a California Admitted Insurer, naming the Chaffey Community College District as Additionally Insured. Commercial General Liability coverage for bodily injury and property damage shall not be less than $1,000,000 per occurrence and $2,000,000 in the aggregate.
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Cancel
of
Signature
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Submit
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