Property Use Request Form .pdf

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Original filename: Property Use Request Form.pdf
Title: Property Use Request Form.docx
Author: Mitchell

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Property Use Request Form
Name of Organization/Individual:
Responsible Person who will be present at the event:
Address
Email

Cell Phone

Space(s) to be utilized:

Recital Hall or Recital Hall and Lobby

Purpose:
Date(s) Requested:
Start Time:

End Time:

(30 minutes will be added to start and end time to accommodate set up and clean up)

Expected Number of Participants:

Will there be food/drink?

Special Needs or Requests:
Equipment Needs:
__ Piano
__ Tables (how many?)
__ Chairs (how many?)
Organizations are required to provide certificates of insurance naming Potter Violins as
additional insured. If no insurance is available, additional fees will be incurred. Certificates
must be resubmitted annually. Do you have a certificate of insurance?
Yes
No
Contract is not final until a 50% deposit, $100 cleaning deposit, certificate of insurance and the
Release and Indemnity form have been received. Please do not send anything until you have
been notified that this request has been approved.

1

Potter Violins: Received on

/ /

Approved by:

Staff Assigned:

2


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