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2. Day/Date of Use*
   Day/Date of Use
3. Usage Times*
   Usage Times Start Time

   —

   Usage Times End Time
5. Name of User/Organization (21 years or older)*
7. Activity To Be Held*
9. User Contact Phone
   Business
10. User Contact Phone
    Home
12. Address
14. City
15. State
16. Zip
18. Supervision

    1. Paid

    1. Mutually Agreeable Volunteer
19. Name
21. Equipment Requested To Be Supplied
23. Additional Equipment To Be Brought In
25. CANCELLATION must be in writing (1) week in advance of date reserved (phone calls are not acceptable) in order to be eligible for a refund. Refunds will be made for severe weather or hazardous conditions. Refunds will only be made through the office at the Community Center.
    
    The Applicant hereby agrees and undertakes to save and hold harmless the City of Fredericksburg from any and all claims for damages to person or property that may arise out of the use of the facility, specified above, without regard to whether the damage, personal or otherwise, is brought about or caused by the negligence of the applicant, the City of Fredericksburg, or any other person, organization, firm or corporation.
    
    The Applicant will be responsible for, and agree to pay for, damages done to the property and equipment of the City, exclusive of ordinary wear and tear.
    
    The Applicant has read and will abide by the Maury Commons Facility Rules & Department policies and cleaning requirements.
    
    NOTE: Parking for use of this meeting space is ‘street parking’ and is available on a first-come, first-served basis. All applicable public parking rules and regulations apply.
27. Applicant - Full Legal Name (Print)
28. Date
    Date
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit Submit and Print

* indicates a required field