Club Room Agreement

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: _________________________________________________________



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: ___________________________________________________


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