Building Use Request Form

* Indicates required field

Name of Group *

Purpose of the function or the activity being requested *

Your name (person responsible) *

First

Last

Phone Number *

Your email *

Date(s) M/D *

Time Of Check In *

Time Of Check Out *

Is this a one-time or repetitive event? *

If repeats, how often and duration (end date) for use request *

Have you rented from us before? *

How did you hear about us? *

Additional Important Information
We ask for donations to cover costs such as utilities, janitorial, and bathroom supplies. This must be paid before you meet unless other arrangements have been made.

How to pay for the room use:
1) You can pay on-line with a credit card at this web site on the DONATE NOW page or
2) You can mail a check made out to CEKC-OLESS to: OLESS, P. O. Box 321, Lyle, WA 98635 or
3) Give a check or cash to the OLESS Treasurer or Activity Manager who will be in contact with you regarding the rental

Standard donation rates per room are:

Children’s Programming $10.00 Per Hour
Two Hour Meeting $25.00
Half Day Event $40.00 (Up to 4 hours)
Whole Day Event $70.00 (Up to 8 hours)
Weddings/Other Special Days $140 (Both Rooms for Up to 8 hours)

When your meeting is finished, please leave the room neat. Tables and chairs may be left as you set them up for your meeting. You may leave trash in the room receptacles.

We reserve the right to bill you for damages. Please communicate the requirements listed here to the rest of your group.

Responsible person agrees to hold harmless, indemnify and defend LAC (including LAC agents, members, tenants and representatives) from any and all liability for injury or damage including, but not limited to, bodily injury, personal injury, emotional injury, or property damage which may result from any person using the above described premises, its entrances and exits, and surrounding areas, for User’s purposes, regardless of whether such injury or damage results from the negligence of the LAC (including LAC’s agents, members, tenants and representatives) or otherwise.

Can you provide proof of liability insurance if requested (i.e. Home Owners Insurance)? Select One *

Your digital signature (using full name) indicates that you agree to all the terms stated in this Building Use Request Form *

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