Room Rental Request Form

Room Rental Request Form to host an event in our smoke and alcohol free facility.

* Indicates required field

Name *

First

Last

Group/Organization Name (If applicable) *

Phone Number *

Email Address *

Reason for Room Rental *

Date Requested *

Time Requested *

Room Requested *

Lower Auditorium (accessible) Lower West (accessible) Upper Auditorium Upper West

Check if you need kitchen facilities *

Yes

Approximate # of Attendees: *

HFA Room Understanding:
The use of HFA facilities: the building, grounds, recreational areas, parking lots, etc., requires a formal request made on this form for the Group Representative. All requests require prior approval and are granted at discretion of the HFA Director. There will be a representative of Hitchcock Academy on site during the time of usage.

A copy of the Hitchcock Academy's Rules and Regulations and Emergency Procedures is attached. The use of alcohol or tobacco on the premises or promoting political or religious activities is prohibited. The Group Representative is responsible for the proper supervision of its activities, unless arrangements for supervision are expressively provided for the HFA administration in advance. All Group Programs involving youths under age 18 shall have a minimum of 1:10 adult to child ratio, at the discretion of the Director, for supervision. Any direct expenses required by a group using the facility will be charged to that group at cost. For request outside normal Academy working hours, a fee of $50 an hour will be assessed to help defray the cost of operating the facility. As the Group Representative signing the application, I acknowledge the terms and conditions as stated above. I agree to abide by the rules and regulations of the Academy and have received a copy of those rules and regulations with the emergency procedures. I agree to hold harmless Hitchcock Free Academy and its employees in the event of property loss or personal injury.

Type the group representative's name and date in the box below to confirm agreement with the regulations outlined by this agreement. *

For Office Use Only:

Approved By: *

Date: *

HFA Staff Working: *

Submit