West Branch Senior Center Reservation Form

Instructions: Complete all information requested and return to the West Branch Housing Department, 200 S Valley Street, West Branch MI 48661, 345-0860.

RENTAL POLICY:

For-profit activities, private functions, fundraisers and similar functions may be charged according to the following:

Residents/property owners of the City of West Branch, West Branch Township or Edwards Township the following applies:

Up to two hours $30   2 to 4 hours $50   Over four hours $70

Non-resident fees:  

Up to two hours $50    2 to 4 hours $85    Over four hours $125

Non-Profit (non fundraising activity)**

Up to two hours $15    2 to 4 hours $25    Over four hours $35

**Non-Profit holding fundraising events will be charged the regular fee, based on where they are located.

Deposit of $150, proof of liability insurance and a signed hold harmless/indemnification agreement may be required prior to rental of the building. Security deposit may be returned following use provided the building is not damaged or left in an unclean condition. Owners of property in the City of West Branch, West Branch Township and Edwards may waive the security deposit provided they sign a statement allowing any charges for misuse of the building to be attached to their property as a lien via the controlling municipality’s tax collection authority. A reservation confirmation will be sent to you.

If you are serving food to the general public, you must obtain a food handlers license from District #2 Health Department.

ALL RESERVATIONS ARE SUBJECT TO THE RESERVATION POLICY CONCERNING SENIOR CENTER USAGE.

TO BE COMPLETED BY APPLICANT (Please type of print):

Name:_____________________________________________________________________

Address:___________________________________________________________________

City:______________________________________ State:___________ Zip:____________

(H) PHONE: __________________________ (W) PHONE: _________________________

Dates & Times of desired use:________________     ________(am/pm) to ________(am/pm)

Number in party:________________ Type of occasion:____________________________

Amount Enclosed: $___________ (Make checks payable to City of West Branch.  A separate check needs to be written for the rental fee and the security deposit.)

Agreement: I have received, read and agree to abide by the rental policy, as well as all conditions contained on this application.

Applicant Signature:_____________________________________ Date:_____________


HOLD HARMLESS AGREEMENT

To the fullest extent permitted by law I or on behalf of my organization, agree to defend, pay in behalf of, indemnify and hold harmless the City of West Branch, its elected and appointed officials, employees and volunteers and others working on behalf of the City of West Branch against any and all claims, demands, suits, or loss, including all costs connected therewith, and for any damages which may be asserted, claimed or recovered against or from the City of West Branch, its elected and appointed officials, employees, volunteers or others working on behalf of the City of West Branch, by reason of personal injury, including, bodily injury and death and/or property damage, including loss of use thereof, which arises out of or is in any way connected or associated with myself or my organization.

_____________________________________     __________________

Signature                                                                 Date

As approved by City Council on June 2, 2003