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Room Rental Form
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Downtown Activity Center Room Rental Form
Date of Request
Date of Request
Driver's License Number
Name of Organization
Is your meeting open to the public or private?
Will this meeting be free to attendees?:
Is your organization for profit or non-profit?
Will products be sold or marketed to attendees?
Will food or drinks be served?
Number of Attendees?
Do you agree to abide by all DACpolicies and, if the facility is not left in the condition in which it was found,agree to pay for damages?
Event Time Span
Event Time Span Start Time
Event Time Span End Time
Please describe your event.
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
I assume all risks and hazards directly related to and incidental to rental of the Downtown Activity Center. I hereby waive, release,absolve, indemnify and agree to hold harmless the City of Bentonville, the sponsors, supervisors and participants for any claim arising out of an injury by myself or anyone who may be attending my event.
I understand by signing this form that I assume full responsibility for the condition of the room or rooms that I am renting from the Bentonville Parks and Recreation Department. I understand that if I don't return the room in the condition that it was before my event, Imay be charged for the cost of cleaning or repairs. By signing this form I understand that as the renter I am solely responsible for any damage that occurs to the room during my rental. I also understand that I am responsible for the actions of those who in attendance at the event for which I am renting the room.
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