Facility Use Application

Benton County Fire District #1

Application to Use Facility
Benton County Fire District #1 wishes to encourage use of fire facilities by the community, as long as the use is for a lawful purpose and does not interfere with the conduct of Fire District business, the primary purpose of which the buildings and grounds are intended.

Permission to use a particular facility may be denied based on a belief that the activity proposed may not be in the Fire District’s interests, or due to the level of previously scheduled use. No person shall be denied the full enjoyment of the facilities because of race, creed, color, sex, or origin.
Applicants Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Name of Organization
Purpose of Facility Usage*
Facility Requested*
Facility and Equipment Needs*

Use of Meeting Room, Kitchen, and RestroomsUse of Fire Station Garage BaysUse of ChairsUse of TablesGroundsOther
Start Time and Date of Activity*

MonthDayYear
Date
Hour MinutesAM/PM Option
End Time and Date of Activity*

MonthDayYear
Date
Hour MinutesAM/PM Option
FACILITY RENTAL FEES will be charged at $50 per event. Charges
shown on the application form are to be made to the district prior to the event. The district reserves the right to require and charge for custodial and/or other authorized district employees to be on the premises.

AGREEMENT AND INSURANCE
The person or organization entering into this agreement with Benton County Fire District #1 for the use of facilities or equipment described above certifies that the information given in this application is current. The undersigned further states that they have the authority to make this application for the applicant and agrees that the applicant will observe all rules and regulations. The applicant further agrees to reimburse the Fire District for any damage arising from the applicant’s use of said facilities. Any accident involving injury to participants or damages to facilities or equipment occurring during the use of facilities or equipment will be reported to Fire District authorities immediately.

The user of the Fire District facilities must hold Benton County Fire Distgrict #1 and it's employees harmless from any and all claims by any person arising from the use of the premises except for the sole negligence of Benton County Fire District #1.

Each application for use of facilities shall be evaluated as to the need for the applicant to provide proof of bodily injury and property damage liability coverage. Proof of insurance must be provided prior to the use of the facilities. The Fire Chief or designee may qualify applications as a district-approved activity on a case-by-case basis.
Attach Proof of Insurance

Cancelof
Signature*

Clear
Date*

MonthDayYear
Date
Form Revision Date

MonthDayYear
Date
Should be Empty:

Benton County Fire District #1