Canyon Community Center Rental Request Form

2. Rental Request Form
   Canyon Community Center<br> P.O. Box 187<br> 126 Lion Boulevard<br> Springdale, UT 84767<br> <br> Phone: 435-772-3434<br> Fax: 435-772-3952<br> <br> <center><em>Do not submit fees/deposits with this form. Use the Rental Policy to fill out the following.</em></center>

   Canyon Community Center
   P.O. Box 187
   126 Lion Boulevard
   Springdale, UT 84767
   
   Phone: 435-772-3434
   Fax: 435-772-3952
   
   

   Do not submit fees/deposits with this form. Use the Rental Policy to fill out the following.

4. User Information

6. Name*

8. Organization

10. Mailing Address*

12. City*

13. State*

14. Zip Code*

16. Phone Number*

17. Fax Number

18. Email Address*

20. Website

22. Alternate Point of Contact*

23. POC Phone Number*

27. Classification of User
    Check one.

    Check one.

29. Group 1

    1. A - Local Public Agencies
    2. B - Local Security and Welfare Activities

30. Group 2

    1. Local Non-commercial Private Events*
    2. Non-local Non-commercial Private Events

32. Group 3

    1. Non-local Non-profit Organizations

    (Attach copy of 501(c)3 determination letter with this form.)

33. Group 4

    1. Local Commercial*
    2. Non-local Commercial

35. *Attach with this form proper verification to receive the local rate. See definition of a local in Rental Policy.

37. Form Attachments

41. Room Rental & Use
    Check applicable boxes.

    Check applicable boxes.

43. Rooms

    1. 3-part Auditorium
    2. Performance Room
    3. Library Room
    4. Crafts Room/Kitchen
    5. Amphitheater
    6. Gallery*

    *Gallery floor available only with rental of 3-part auditorium.

44. Additional Equipment

    1. TV/VCR/DVD
    2. Projector
    3. Microphone/Sound
    4. Stage
    5. Dance Floor
    6. Baby Grand Piano

48. Description of Event

50. Name of Event*

52. Description of Event

    Example: meeting, wedding, etc.

54. Estimated Attendance:
    1 adult per 10 youth attendees required.

    1 adult per 10 youth attendees required.

56. Adults*

57. Youth (Under 16)*

59. Please check the following that apply to the event:*

    1. The event will have food served.
    2. The event will be catered.
    3. The event is open to the public.
    4. Admission will be charged.
    5. Alcohol will be served.

61. Caterer's Name

62. Purpose of Admission Fee

64. If alcohol will be served, DABC Single Event Permit and additional insurance may be required. See Alcohol Permits and Insurance in Rental Policy.

68. Date/Time
    Visit the Springdale town website to check availability.

70. Example
    A four-hour event on the 8th of December 2007 starts at 5pm. The caterers need to arrive an hour early and general clean-up requires ½ an hour. The entire event rental will be for 5 ½ hours and renter will be charged for an 8 hour period.<br><br> The information required should be entered below as:<br> <b>Date(s) mm/dd/yy</b><br> 12/08/2007<br> <b>Set-up</b><br> 4 - 5 p.m.<br> <b>Function</b><br> 5 - 9 p.m.<br> <b>Clean-up</b><br> 9 - 9:30 p.m.<br> <b>Total Hours</b><br> 5.5 hours

    A four-hour event on the 8th of December 2007 starts at 5pm. The caterers need to arrive an hour early and general clean-up requires ½ an hour. The entire event rental will be for 5 ½ hours and renter will be charged for an 8 hour period.
    
    The information required should be entered below as:
    Date(s) mm/dd/yy
    12/08/2007
    Set-up
    4 - 5 p.m.
    Function
    5 - 9 p.m.
    Clean-up
    9 - 9:30 p.m.
    Total Hours
    5.5 hours

72. Single Event 1st Choice
    Use additional columns for multiple day events.

    Use additional columns for multiple day events.

74. Date*
    Date

75. Date
    Date

76. Date
    Date

77. Date
    Date

79. Set-up*
    Set-up Start Time

    —

    Set-up End Time

80. Set-up
    Set-up Start Time

    —

    Set-up End Time

81. Set-up
    Set-up Start Time

    —

    Set-up End Time

82. Set-up
    Set-up Start Time

    —

    Set-up End Time

84. Function*
    Function Start Time

    —

    Function End Time

85. Function
    Function Start Time

    —

    Function End Time

86. Function
    Function Start Time

    —

    Function End Time

87. Function
    Function Start Time

    —

    Function End Time

89. Clean-up*
    Clean-up Start Time

    —

    Clean-up End Time

90. Clean-up
    Clean-up Start Time

    —

    Clean-up End Time

91. Clean-up
    Clean-up Start Time

    —

    Clean-up End Time

92. Clean-up
    Clean-up Start Time

    —

    Clean-up End Time

94. Total Hours*
    Total Hours

95. Total Hours
    Total Hours

96. Total Hours
    Total Hours

97. Total Hours
    Total Hours

99. Single Event Alternative
    Use additional columns for multiple day events.

    Use additional columns for multiple day events.

101. Date*
     Date

102. Date
     Date

103. Date
     Date

104. Date
     Date

106. Set-up*
     Set-up Start Time

     —

     Set-up End Time

107. Set-up
     Set-up Start Time

     —

     Set-up End Time

108. Set-up
     Set-up Start Time

     —

     Set-up End Time

109. Set-up
     Set-up Start Time

     —

     Set-up End Time

111. Function*
     Function Start Time

     —

     Function End Time

112. Function
     Function Start Time

     —

     Function End Time

113. Function
     Function Start Time

     —

     Function End Time

114. Function
     Function Start Time

     —

     Function End Time

116. Clean-up*
     Clean-up Start Time

     —

     Clean-up End Time

117. Clean-up
     Clean-up Start Time

     —

     Clean-up End Time

118. Clean-up
     Clean-up Start Time

     —

     Clean-up End Time

119. Clean-up
     Clean-up Start Time

     —

     Clean-up End Time

121. Total Hours*
     Total Hours

122. Total Hours
     Total Hours

123. Total Hours
     Total Hours

124. Total Hours
     Total Hours

126. Re-Occurring Use 1st Choice

128. Dates (Starting & Ending)
     Dates (Starting & Ending) Start Date

     —

     Dates (Starting & Ending) End Date

130. Weekly

     1. Sunday
     2. Thursday

     1. Monday
     2. Friday

     1. Tuesday
     2. Saturday

     1. Wednesday

132. Monthly

     1. 1st
     2. 2nd
     3. 3rd
     4. 4th

133. Day

     1. Sunday
     2. Monday
     3. Tuesday
     4. Wednesday

     1. Thursday
     2. Friday
     3. Saturday

134. Or: Date of the Month

136. Other (explain):

138. Time of Use:

140. Set-up
     Set-up Start Time

     —

     Set-up End Time

141. Function
     Function Start Time

     —

     Function End Time

142. Clean-up
     Clean-up Start Time

     —

     Clean-up End Time

143. Total Hours
     Total Hours

145. Re-Occurring Use Alternative

147. Dates (Starting & Ending)
     Dates (Starting & Ending) Start Date

     —

     Dates (Starting & Ending) End Date

149. Weekly

     1. Sunday
     2. Thursday

     1. Monday
     2. Friday

     1. Tuesday
     2. Saturday

     1. Wednesday

151. Monthly

     1. 1st
     2. 2nd
     3. 3rd
     4. 4th

152. Day

     1. Sunday
     2. Monday
     3. Tuesday
     4. Wednesday

     1. Thursday
     2. Friday
     3. Saturday

153. Or: Date of the Month

155. Other (explain):

157. Time of Use:

159. Set-up
     Set-up Start Time

     —

     Set-up End Time

160. Function
     Function Start Time

     —

     Function End Time

161. Clean-up
     Clean-up Start Time

     —

     Clean-up End Time

162. Total Hours
     Total Hours

166. Submitting this form does not constitute a contract. Canyon Community Center will contact you within five working days regarding your request. Pricing and/or conditions subject to change without notice.
     The undersigned, hereby agrees to be responsible for any damages to the facility occurring during and by this use, and agrees to be responsible for the conduct of all persons attending this function. Applicant further agrees to be responsible for any accident or injury occurring to anyone during and by this use, and agree that the Town of Springdale, its officers and employees, shall not be responsible for any such injury of loss, except as arises from the sole willful act, omission or sole negligence of the Town of Springdale, its officers or employees. The undersigned has received a copy of the Facility Use Policy and agrees to comply with the rules and regulations listed therein.

     The undersigned, hereby agrees to be responsible for any damages to the facility occurring during and by this use, and agrees to be responsible for the conduct of all persons attending this function. Applicant further agrees to be responsible for any accident or injury occurring to anyone during and by this use, and agree that the Town of Springdale, its officers and employees, shall not be responsible for any such injury of loss, except as arises from the sole willful act, omission or sole negligence of the Town of Springdale, its officers or employees. The undersigned has received a copy of the Facility Use Policy and agrees to comply with the rules and regulations listed therein.

168. Electronic Signature*

169. Date*
     Date

Leave This Blank:


170. 1. Receive an email copy of this form.
171. Email address

     This field is not part of the form submission.

172. Submit Submit and Print

* indicates a required field