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Doris Buffett Pool Rental Form

3. Doris E. Buffett Pool

   <center>1300 Dixon Street</center> <center>Fredericksburg, VA 22401</center> <center>PHONE: (540) 310-0665 FAX: (540) 372-3475</center>

   1300 Dixon Street Fredericksburg, VA 22401 PHONE: (540) 310-0665 FAX: (540) 372-3475

5. Doris E. Buffett Pool can only be rented on the days/times listed below:

   <br>Friday: 7:30 p.m. to 10:30 p.m.<br> Saturday: 7:30 p.m. to 10:30 p.m.<br> Sunday: 7:00 p.m. to 10:00 p.m.

   
   Friday: 7:30 p.m. to 10:30 p.m.
   Saturday: 7:30 p.m. to 10:30 p.m.
   Sunday: 7:00 p.m. to 10:00 p.m.

7. Rental Fees:

   $150 deposit for all groups to reserve the time, refundable if no damage done to pool area, if renter leaves on time and cleans up after group. Deposit is in addition to rental fee.<br><br> $200 for 50 people or less (no more than 50 people will be allowed in pool area)<br><br> $300 for 51-100 people (no more than 100 people will be allowed in pool area)<br><br>Larger group rentals must be approved by Director and rate will be determined by size of the group.

   $150 deposit for all groups to reserve the time, refundable if no damage done to pool area, if renter leaves on time and cleans up after group. Deposit is in addition to rental fee.
   
   $200 for 50 people or less (no more than 50 people will be allowed in pool area)
   
   $300 for 51-100 people (no more than 100 people will be allowed in pool area)
   
   Larger group rentals must be approved by Director and rate will be determined by size of the group.

9. Payment must be made at the same time as the reservation.

   Payment Form

11. Date of Event*
    Date of Event

12. Times You will Be At The Pool*
    Times You will Be At The Pool Start Time

    —

    Times You will Be At The Pool End Time

14. Associated with a Special Event:

    1. Yes
    2. No

15. If so, which one?

17. Event Title*

18. Type of Event*

19. Estimated Attendance*

21. Group

22. Contact Name*

24. Day Phone*

25. Evening or Cell Phone

27. Address*

29. City*

30. State*

31. Zip*

33. Email Address*

35. Person Responsible for Clean Up*

36. Phone*

38. Send Refund To (if different from above)

40. Address

42. City

43. State

44. Zip

46. In consideration for the use of Doris E. Buffet Pool, 1300 Dixon St., Fredericksburg, VA for myself and all my legal representatives do hereby agree and undertake to save and hold harmless, release and forever discharge the City of Fredericksburg, its officers, agents, employees and any and all other persons, firms and corporations, acting on behalf of the City from any and all actions, demands or claims for damages to persons or property, that may arise out of the use of said City property specified here, without regard to a negligent act or omission of the applicant, the City of Fredericksburg, or any other person, organization , firm, or corporation acting on behalf of the City.

    CANCELLATION POLICY: Full refund will be given IF your cancellation is received 10 business days in advance of your date. Less than 10 business days, a $50.00 cancellation fee will applied. Deposit will be adjusted for having over the number of approved people.

    CANCELLATION POLICY: Full refund will be given IF your cancellation is received 10 business days in advance of your date. Less than 10 business days, a $50.00 cancellation fee will applied. Deposit will be adjusted for having over the number of approved people.

48. Review Pool Policies

    Doris E. Buffett Pool General Policies

50. By my signature below, I certify that I have received a copy of, read, and fully understand my rental contract, the general policies for Doris E. Buffett Pool, and the prescribed responsibilities for Doris E. Buffett Pool lessees. I further understand that my failure to meet any of these responsibilities or comply with any policy may result in the immediate termination of the rental agreement by the on-site facility supervisor. I also agree that, if termination of the rental agreement is deemed necessary by the supervisor, I will ask that my guests exit the facility in a quick and orderly fashion and personally oversee the clean-up of the rental space. Finally, I understand and agree that, should early termination of my rental contract become necessary, I will receive no refund of rental fees and my deposit may be withheld.

52. Lessee Signature: I understand that checking the box below is the equivalent of signing my name.*

    1. I Accept:

54. Lessee Name*

55. Date*
    Date

57. Full payment must be received within 5 business days to complete reservation upon approval with Parks and Recreation*

    1. I Accept

Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit Submit and Print

* indicates a required field