Club Room Agreement

I, _________________________________________, a temporary user of the Hutchinson County Clubroom, have read and understand the above fees and procedures for renting and using the Library Clubroom.  If key is returned on time and no damage is found, my deposit will be returned to me.  I also understand, if I violate the fees and procedures, I will forfeit any future usage of this facility as well as all or a portion of my deposit.

Name: _______________________________________Phone: __________

Address: _________________________________City _________ST: ____

Zip: __________________________________

Date of Use:  __________________________________________________

Event:  _______________________________________________________

Library Use Only

 RECEIVED

Rent; $ ________     Date:  __________ Staff:  _______________________

Rent; $ ________     Date:  __________ Staff:  _______________________

Deposit: $ __________ Date: __________ Staff:  ____________________

KEY # ISSUED __________ Date: __________ Staff:  _______________

Date KEY Returned: ________________   Staff: _____________________

Authorization to Return Deposit (who): __________ Staff: _____________

Deposit Returned – Date; __________ Amount: $__________ Staff: ______

Signature of person receiving monies:  ______________________________

Printed Name: ___________________________________________

Comments are closed.