Baby Shower Usage Application Form
Baby Shower Usage Application Form Please type or print. Complete the form in its entirety.
Today’s Date:____________________ Date Requested: _____________________________________________ Time of Event: (limited to two hours)** Start Time: _______ a.m. p.m. End Time: ______ a.m. p.m. **Saturday showers must be completed by 4:00 pm.
Approx. # of persons: ______ BABY(S) INFORMATION □ Girl □ Boy □ __________ Baby’s registry is at: ________________________________________________ Baby(s) Due Date:_____________________________ Expected City of Delivery: __________________________ Parents who attend Willmar AG: ________________________________________________________________ Grandparents who attend Willmar AG: ___________________________________________________________
HOSTESS CONTACT INFORMATION Name of Hostess: ____________________________________________________________________________ Address: ___________________________________________________________________________________ Home Phone:_______________________________ Cell Phone: ______________________________________ Hostesses are responsible for setup, teardown and cleanup. As always, we ask that you “leave it better than you found it.”
□ Fireside Room (1-50 people) □ 1/2 Fellowship Hall (over 50) □ Please choose your setup style: □ Tables/Chairs (6 round tables) □ Chairs only (approx. 50) Tables available: □ 4 ft. table (used for punch) □ 6 ft. table for food □ 6 ft. table for gifts Tableclothes are available for $3 per table. I □ will □ will not be using them. A sofa, two chairs and a coffee table are available for use. I □ will □ will not be using them. Please choose your location:
___________
There will be a $15.00 charge for someone to open/lock the facilities unless you know someone who has a key that would be willing to do that for you. Person with key: ___________________________________________
Please diagram the room arrangement for your event.
A. ASSUMPTION OF KNOWN RISKS. To induce the Church to permit you to hold your event at its property, you hereby to assume the “Known Risks” associated with Church facilities. Specifically: 1. If you are injured as a result of the occurrence of one of these Known Risks, then you will look first to your own insurance company for coverage. You will then look to the applicable insurance carried by Willmar AG, but only to the extent of applicable limits. As a condition precedent to you and your attendees utilization of Church property, you and your attendees agree that you and your attendees will not assert any claim or judgment against the assets of the Church and its affiliates in excess of their of applicable insurance coverage. 2. These “Known Risks” include, but are not limited to, indoor and outdoor sports, kitchen facilities and activities, showers and bath facilities and activities, playground facilities and activities, and all other necessary or related activities including, but not limited to, the set-up or clean-up of these facilities or activities. B. VOLUNTARY AGREEMENT TO LIMIT CLAIMS FOR NEGLIGENCE TO THE AMOUNT OF APPLICABLE INSURANCE. As consideration offered to induce Willmar AG to agree to accept this Application, you and your attendees agree to voluntarily limit your “Claims” for damages to the amount of applicable insurance. All losses or expenses in excess of the amount of applicable insurance must be borne by your and your Attendees. The word “Claims” means costs, expenses, claims or damages arising from negligence, gross negligence, strict liability, derivative liability or otherwise, including injury, accident, sickness, loss or accident losses or additional expenses due to delays or changes in motor coach, train, airplane services, or that of any other conveyance, weather, strikes, war, quarantine, or other causes. C. INDEMNITY FOR WILLMAR AG. To the extent you and your attendees have applicable insurance coverage, you will indemnify, protect, defend, and hold Willmar AG harmless for, from and against all costs, Claims, and charges arising from this event whether caused by Willmar AG, its agents, employees, independent contractors, or otherwise. Willmar AG is not required to provide supervision for any of your attendees at any time. You agree to provide supervision for your attendees. D. CERTIFICATE OF INSURANCE. (ORGANIZATIONS/BUSINESSES ONLY) You will provide a certificate of insurance, three weeks prior to the event date, naming Willmar AG as additional insured on a policy with no less than a minimum of a $1,000,000 general liability E. MEDIA PERMISSION. You and your attendees grant a license and permission to Willmar AG or their designees, and their employees, successors, assignees, licensees and agents to utilize you and your attendees appearance, image, voice and likeness, in perpetuity, in any and all manner and form and format of media throughout the world, now known or hereafter devised, including but not limited to recordings, television broadcasts, or web-casts of the event you are attending. F. COMPLIANCE WITH LAWS. You and your attendees agree and warrant that you will comply with all applicable laws, ordinances, and rules including, but not limited to, laws requiring the presence of an off-duty police officer at your event. You shall be solely responsible for the cost associated with compliance with law, ordinances, and rules related to your event to be held at the Church’s property. I have received and read the Facility Usage & Procedure Agreement and understand that by submitting this application for use I am hereby agreeing to abide by all procedures, fees, and policies stated in the agreement. I also understand that application for facility use is not a guarantee to use the facility. I will be notified following the next staff meeting if my request is approved or denied. *Applicable usage fee(s) must be received prior to the date of your event. Signature:____________________________________________Date: __________________________________ Office Use Only: Application is:
□ Approved □ Denied
Applicant Notified: ____________________________________
□ No Fee Required. □ $______ Tablecloth Usage Charge □ $15.00 Charge for Opening Door Payment Amount Received: Check #______________ Date: __________________________________________________ Comments: __________________________________________________________________________________________ Staff Initials:_______
2/2016
_____Building Supervisor _____Custodian _____Sound Tech
Today’s Date:____________________ Date Requested: _____________________________________________ Time of Event: (limited to two hours)** Start Time: _______ a.m. p.m. End Time: ______ a.m. p.m. **Saturday showers must be completed by 4:00 pm.
Approx. # of persons: ______ BABY(S) INFORMATION □ Girl □ Boy □ __________ Baby’s registry is at: ________________________________________________ Baby(s) Due Date:_____________________________ Expected City of Delivery: __________________________ Parents who attend Willmar AG: ________________________________________________________________ Grandparents who attend Willmar AG: ___________________________________________________________
HOSTESS CONTACT INFORMATION Name of Hostess: ____________________________________________________________________________ Address: ___________________________________________________________________________________ Home Phone:_______________________________ Cell Phone: ______________________________________ Hostesses are responsible for setup, teardown and cleanup. As always, we ask that you “leave it better than you found it.”
□ Fireside Room (1-50 people) □ 1/2 Fellowship Hall (over 50) □ Please choose your setup style: □ Tables/Chairs (6 round tables) □ Chairs only (approx. 50) Tables available: □ 4 ft. table (used for punch) □ 6 ft. table for food □ 6 ft. table for gifts Tableclothes are available for $3 per table. I □ will □ will not be using them. A sofa, two chairs and a coffee table are available for use. I □ will □ will not be using them. Please choose your location:
___________
There will be a $15.00 charge for someone to open/lock the facilities unless you know someone who has a key that would be willing to do that for you. Person with key: ___________________________________________
Please diagram the room arrangement for your event.
A. ASSUMPTION OF KNOWN RISKS. To induce the Church to permit you to hold your event at its property, you hereby to assume the “Known Risks” associated with Church facilities. Specifically: 1. If you are injured as a result of the occurrence of one of these Known Risks, then you will look first to your own insurance company for coverage. You will then look to the applicable insurance carried by Willmar AG, but only to the extent of applicable limits. As a condition precedent to you and your attendees utilization of Church property, you and your attendees agree that you and your attendees will not assert any claim or judgment against the assets of the Church and its affiliates in excess of their of applicable insurance coverage. 2. These “Known Risks” include, but are not limited to, indoor and outdoor sports, kitchen facilities and activities, showers and bath facilities and activities, playground facilities and activities, and all other necessary or related activities including, but not limited to, the set-up or clean-up of these facilities or activities. B. VOLUNTARY AGREEMENT TO LIMIT CLAIMS FOR NEGLIGENCE TO THE AMOUNT OF APPLICABLE INSURANCE. As consideration offered to induce Willmar AG to agree to accept this Application, you and your attendees agree to voluntarily limit your “Claims” for damages to the amount of applicable insurance. All losses or expenses in excess of the amount of applicable insurance must be borne by your and your Attendees. The word “Claims” means costs, expenses, claims or damages arising from negligence, gross negligence, strict liability, derivative liability or otherwise, including injury, accident, sickness, loss or accident losses or additional expenses due to delays or changes in motor coach, train, airplane services, or that of any other conveyance, weather, strikes, war, quarantine, or other causes. C. INDEMNITY FOR WILLMAR AG. To the extent you and your attendees have applicable insurance coverage, you will indemnify, protect, defend, and hold Willmar AG harmless for, from and against all costs, Claims, and charges arising from this event whether caused by Willmar AG, its agents, employees, independent contractors, or otherwise. Willmar AG is not required to provide supervision for any of your attendees at any time. You agree to provide supervision for your attendees. D. CERTIFICATE OF INSURANCE. (ORGANIZATIONS/BUSINESSES ONLY) You will provide a certificate of insurance, three weeks prior to the event date, naming Willmar AG as additional insured on a policy with no less than a minimum of a $1,000,000 general liability E. MEDIA PERMISSION. You and your attendees grant a license and permission to Willmar AG or their designees, and their employees, successors, assignees, licensees and agents to utilize you and your attendees appearance, image, voice and likeness, in perpetuity, in any and all manner and form and format of media throughout the world, now known or hereafter devised, including but not limited to recordings, television broadcasts, or web-casts of the event you are attending. F. COMPLIANCE WITH LAWS. You and your attendees agree and warrant that you will comply with all applicable laws, ordinances, and rules including, but not limited to, laws requiring the presence of an off-duty police officer at your event. You shall be solely responsible for the cost associated with compliance with law, ordinances, and rules related to your event to be held at the Church’s property. I have received and read the Facility Usage & Procedure Agreement and understand that by submitting this application for use I am hereby agreeing to abide by all procedures, fees, and policies stated in the agreement. I also understand that application for facility use is not a guarantee to use the facility. I will be notified following the next staff meeting if my request is approved or denied. *Applicable usage fee(s) must be received prior to the date of your event. Signature:____________________________________________Date: __________________________________ Office Use Only: Application is:
□ Approved □ Denied
Applicant Notified: ____________________________________
□ No Fee Required. □ $______ Tablecloth Usage Charge □ $15.00 Charge for Opening Door Payment Amount Received: Check #______________ Date: __________________________________________________ Comments: __________________________________________________________________________________________ Staff Initials:_______
2/2016
_____Building Supervisor _____Custodian _____Sound Tech
