PALMYRA R-1 CONTRACT FOR USE OF FACILITY
HOLD HARMLESS AGREEMENT
Name *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Representing Group
Your answer
WE/I protect, indemnify, save and keep harmless, Palmyra R-I School District and Palmyra R-I School Board against and from any and all loss, cost, damage or expense, arising out of or from any accident or other occurrence on or about said premises causing injury to any person or property, including injury to ourselves and will protect, indemnify and save and keep harmless the above mentioned parties from any and all claim, cost, or expense arising out of our use of the following:
I would like to reserve *
for the purpose of (examples Softball Practice, Basketball Practice, etc) *
Your answer
and agree to comply with and perform all the requirements and provisions agreed to and required by Palmyra R-I Schools.
I understand that I can request to reserve gymnasium times for two weeks at a time and a maximum of two blocks of time per building each week. Your request will be sent to the building secretary of the building you request to use. The secretary will process your request and confirm available times within one week of your request being made.
Please complete gym rental requests two weeks prior to the dates you wish to use the facility. We cannot guarantee that gyms will always be available for use
I would like to request to use *
I request to use the gym on the following two dates: *
MM
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DD
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YYYY
and *
MM
/
DD
/
YYYY
The following students will be under my supervision during the time I have requested to use the facility:
Your answer
You will be required to sign the Hold Harmless agreement when you pay the rental fee.
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