Facility Use Reservation Nature of Event * Date(s) Requested * Area(s) Requested * Set-Up Time * Actual Start Time * End Time * Contact Information: Name * Organization * Address * City, State, Zip * Phone * Fax Email * Equipment Requested (check all those that apply): Folding Tables Folding Chairs Catering Accessibility Support Podium P.A. System Microphone Wireless Microphone TV/VCR/DVD Projector & Screen Internet Access PowerPoint Equipment Smartboard Satellite Downlink Teleconference (ITV) Comments (provide set-up and/or other equipment needs): This is a request for facility use only, not a guarantee of facility usage. When all required approvals have been obtained, an Event Order Contract will be sent to the requestor for signature. When the signed contract, along with the applicable Certificate of Insurance (see General Terms & Conditions, Page 2, Item #7), are received by the Business Office, the facility usage will be confirmed, sent to the requestor, and placed on the Events Management Schedule. Please note that a signed Event Order Contract and all applicable supporting documentation must be received by the Business Office by Noon on the second business day prior to the requested event date. General Terms & Conditions Only that part of the facility for which the request is made shall be used. Other classrooms, storerooms, offices, etc. will not be used. Only the equipment requested will be used. Proper care will be given the building and the contents therein. Financial responsibility will be assumed individually and on behalf of said organization for damage, loss, or injury arising from this use. If the event involves minors, ample supervision will be in attendance the entire time of the event. Jefferson College buildings are smoke free; there is NO SMOKING in any part of the College buildings. Conduct of all persons making use of College facilities and equipment shall be in compliance with all local, state, and federal laws. A certificate of liability insurance may be required by the College for use of College facilities. The certificate shall declare Jefferson College harmless in the event of bodily injury or property damage. Regardless, Jefferson College will not be liable for any loss or damage to personal property or personal injury resulting from use of college facilities by outside organizations. Alcoholic beverages or controlled substances will not be present at any time on College property. Use of alcoholic beverages or controlled substances on campus will result in immediate termination of scheduled event. Gambling of any kind is prohibited on College property. The College reserves the right to request said organization to furnish information in addition to that appearing on this form and which may be deemed by college officials to be reasonable and proper in connection with use of facilities by said organization. It shall be the policy of the Board of Trustees that the use of college facilities be authorized for those non-college organizations requesting such use subject to the following conditions. The educational programs, functions, and events of Jefferson College shall take precedence in all casesover requests for community use. The college administration is authorized to exercise control over time, place, location, and levying charges regarding requests for community use. The college administration is authorized to allow the use of physical facilities for the free discussion of public issues or subjects of general public interest, for the meetings of organizations of citizens, and for any other civic, social, or educational purpose, or purpose related to the free expressions of ideas. The college reserves the right to stipulate that specific verbal or written disclaimers on all promotional materials, written or electronic, be a requisite for permission to use the facility, if in the judgment of the administration, adverse or unjust criticisms may fall upon the college because of the potential controversy surrounding a particular organization, individual, or event/activity. College officials shall establish and administer the necessary rules and regulations for the use of facilities. Leave this field blank CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Math question * 14 + 3 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.