Pickens Doodle Park AnMed Health Cannon Pavilion Use Request

Pickens Doodle Park AnMed Health Cannon Pavilion Use Request Application

Name of Company/Organization*

Name of Responsible Party*

First

Last

Address*

Street Address City State / Province / Region Postal / Zip Code

Email*

Phone*

Date and Time of the Rental of the Facility Requested:*

Describe you activity you're requesting to rent the facility for:*

Facility Use Fee:*

$100 - Includes $25 Refundable Cleaning Deposit

FACILITY USE AGREENMENT AND RELEASE/INDEMNIFICATION

A. In consideration for being permitted to use the facilities of the City of Pickens, (hereinafter "Applicant") agrees to indemnify and hold harmless, the City of Pickens, its officers, employees, and insurers, from and against all liability, claims, and demands, which are incurred, made, or brought by any person or entity, on account of damage, loss, or injury, including without limitation claims arising from property loss or damage, bodily injury, personal injury, sickness, disease, death, or any other loss of any kind whatsoever, which arise out of or are in any manner connected with the use of the facilities, whether any such liability, daims, and demands result from the act, omission, negligence, or other fault on the part of City of Pickens, its officers, or its employees, or from any other cause whatsoever.

B. By Electronically Submitting this request, Applicant agree that, in the event of any damage, loss, or injury to the facilities or to any property or equipment therein, City of Pickens may deduct from the damage deposit the full amount of such damage, loss, or injury. Applicant further agrees that, if such damage, loss, or injury exceeds the amount of the damage deposit, Applicant will within thirty (30) days of billing reimburse City of Pickens for all costs associated therewith upon billing by City of Pickens.

C. In addition, in consideration for being permitting to use the facilities, Applicant, on behalf of itself, and its officers, employees, City of Pickens, and invitees, hereby expressly exempts and releases City of Pickens, its officers, employees, insurers, and self-insurance pool, from and against all liability, claims, and demands, on account of injury, loss, or damage, including without limitation claims arising from property loss or damage, bodily injury, personal injury, sickness, disease, or death, that Applicant may incur as a result of such use, whether any such liability, claims, and demands result from the act, omission, negligence, or other fault on the part of City of Pickens, its officers, or its employees, or from any other cause whatsoever.