2. Rental Request Form
   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.
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.
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.
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.
    
    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.
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.
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.
168. Electronic Signature*
169. Date*
     Date
Leave This Blank:


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

     This field is not part of the form submission.

173. Submit Submit and Print

* indicates a required field