Taft College | Facilities Use Form

Name of Applicant *

Organization, Group, Individual

First Last

Address of Applicant *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Facilities Requested

Location/Address

Building/Room/Grounds/Special Facilities

Area or room(s)

Days of Use

Select a date and time from/to.

Date of Use	From	To	Actions

There are no Days.

Person in Charge

First Last

Description of Activity

Estimated Attendance

Please enter a number from 0 to 999.

Declaration of Applicant

1) Nature or type of intended use *

2) Applicant has received or will receive for the activities herein listed contributions, cash collections, registration fees, admission fees, tuition, donations, or other receipts estimated in amount of

2a) If no receipts anticipated for these activities check here

No receipts anticipated

3) Receipts set forth in item 2 above will be used for

4) Certified Liability agreement. *

I, the undersigned, hereby certify that I will be personally responsible on behalf of the applicant for any damages sustained by the school building, furniture, equipment, or grounds occurring through the occupancy or use of said building and or grounds by the applicant, normal wear and tear excepted.

I agree.

5) I have received and read the rules, regulations, conditions & terms. *

I hereby certify that I have received and read the rules, regulations, conditions, terms and that I and the applicant which I represent, will abide by them and will conform to all applicable provisions of the Constitution and laws of California and to all other rules and regulations of the Board of Education and its authorized agents which may be communicated to the applicant and to the best of my knowledge the school property for use of which this application is hereby made will not be used for the commission of any crime or any act which is prohibited by law.

I agree.

6) Cancellation Agreement *

It is agreed that in the event this permit is canceled by the applicant no refund will be made and that changes in date or extension of time shall be made only as specified by the rules governing use of school facilities.

I agree.

7) Authorization Agreement *

In executing this declaration I certify that I have been duly authorized by the herein set forth applicant to act in its behalf in making application for use of said facilities.

I agree.

HOLD HARMLESS & INDEMNIFICATION AGREEMENT

THE UNDERSIGNED AGREES TO DEFEND, INDEMNIFY AND HOLD HARMLESS THE WEST KERN COMMUNITY COLLEGE DISTRICT,
ITS BOARD OF TRUSTEES, AGENTS AND EMPLOYEES, INDIVIDUALLY AND COLLECTIVELY, FROM AND AGAINST ALL COSTS,
LOSSES, CLAIMS, ACTIONS, AND JUDGMENTS ARISING FROM PERSONAL INJURIES, PROPERTY DAMAGE OR OTHERWISE,
REGARDLESS OF CAUSE, THAT MAY ARISE IN ANYWAY FROM OR BE ALLEGED TO BE CAUSED BY THE UNDERSIGNED’S
USE OR OCCUPANCY OF DISTRICT FACILITIES, FURNITURE OR EQUIPMENT. THE UNDERSIGNED FURTHER AGREES TO
PROVIDE A CERTIFICATE OF INSURANCE FOR LIABILITY COVERAGES SATISFACTORY TO THE DISTRICT (1,000,000).

Email *

Enter Email Confirm Email

Phone *

Taft College Contact *

Signature of Applicant

Facilities Use Form

Declaration of Applicant

For Student Support

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