Individual Contact Name *

First Name

Last Name

Phone Number *

(###)

###

####

Address of Business/Organization *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone number for Event Day *

(###)

###

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Event Start *

MM

DD

YYYY

Event End

MM

DD

YYYY

Requested Time From *

Hour

Minute

Second

AM PM

Requested Time To *

Hour

Minute

Second

AM PM

*

The Lessee shall be responsible for all persons who attend the function and shall ensure that all persons act in an orderly, responsible, and safe manner. Rock Creek Fire District (RCFD) retains the right to terminate the event or expel any person or persons who are deemed to be unruly, unsafe, or acting with dangerous behavior or who are in violation of any of the rules or regulations. In consideration of the use of the premises of Rock Creek Fire District, the undersigned herby releases RCFD, its officers, directors, members and employees (collectively “RCFD Parties”) from any and all suits, actions, compensation, consequential and punitive damages, any and all property damage, personal injuries, illnesses, death resulting from any occurrence or accident that may occur as a result of or arise out of leasing or use of the described premises by the Lessee. The undersigned hereby agrees to indemnify, defend, and hold harmless RCFD and RCFD Parties from any claims brought by any person or entity arising out of or related to this agreement. NOTE: Typing your First and Last name will be considered your signature. Lessee please sign below:

First Name

Last Name

Date of Signature *

MM

DD

YYYY