I, ______________________________________________, a temporary user of the Hutchinson County Club Room, have read and understand the above fees, rules, and procedures for renting and using the Club Room. If the key is returned on time, the Club Room is clean, and no damage is found my deposit will be returned to me. I also understand that if I violate the above agreement 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(s) of Use: ___________________________________________________
Event: _________________________________________________________
LIBRARY USE ONLY
Approval Request sent to Commissioner _______. Date: __________ Staff: ______
Approval (Granted/Denied) by Commissioner ______. Date: ________ Staff: ______
Received Deposit: $_________ (Cash/Check) Date: ____________ Staff: ________
Key #__________ Issued Date: ____________________ Staff: ______________
Date Key Returned: __________________________ Staff: _________________
Post-Event Inspection:
Date Completed: __________________________ Staff: ___________________
Comments (Good or Bad): ___________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Authorization to Return Deposit:
Date: _______________________ Staff: ______________________________
Deposit Returned:
Date: _______________ Amount: $_________ (Cash/Check) Staff: ____________
Signature of person picking up deposit: __________________________________
Printed name: ___________________________________________________
Storytime-Borger