This is not a contract. Once this form is completed it will be reviewed by the athletic department. You will be notified as to the results of your request. If granted, you will be notified of all fees involved. You will be required to sign a rental contract.

Email address *

First name *

Last name *

Address 1 *

City *

State *

ZIP Code *

Cell Phone Number *

Name of group , organization requesting to use the facilities *

Deadline for submission to request a facility is 30 days prior to the event.

Please give a detailed description of this event, including anticipated attendance. *

Date Requested *

Facility(s) requested *

If Multiple Dates, Start Date *

If Multiple Dates, End Date *

Start Time Including Setup *

End Time Including Breakdown *

Will this event need support from any of the following. If so it is your responsibility to make arrangements with those offices. *

Moravian College Facilities Moravian College Food Services Moravian College Media Center Moravian College Housing Campus Safety No Support Needed

What type of event is this *

1. Camp / Clinic - LLC, a for profit activity organized and run directly by a Moravian College coach. 2. Moravian College Camp / Clinic - must be organized and run by a Moravian College coach and all funds raised would benefit Moravian College and that teams sport program account. 3. Moravian College Event 4. Outside Group - Any camp/clinic/event that is not organized and run directly by a Moravian College employee. 5. Community Service Event

Financial Agreements

Site Manager *

Due to the nature of this event we request a waiver of this requirement. Not Applicable

Billing *

I (renter) agree to the above billing process. Not Applicable

INDEMNIFICATION *

I (renter) agree to the above indemnification statement. Not Applicable

FAILURE TO PAY *

I (renter) agree to the above failure to pay process. Not Applicable

DAMAGES *

I (renter) agree to the above damages process. Not Applicable

STATEMENT OF ACCOUNTING *

I agree to provide a statement of accounting at the conclusion of this event. Not Applicable

CANCELLATION *

I (renter) agree to the above cancellation process. Not Applicable

Liability & Legal Agreements

MORAVIAN COLLEGE LIABILITY WAIVER FORM (minor and non-minor). *

I (renter) agree to the Moravian College liability waiver policy. Not Applicable

MEDICAL COVERAGE *

Due to the nature of this event we request a waiver of this requirement. We (renter) will provide medical coverage in accordance with the above Moravian College policy. We ask Moravian College to provide medical coverage. ?A fee schedule will be provided on request.

LICENSEE REVOCATION *

I (renter) agree to the above Licensee Revocation process. Not Applicable

AMENDMENTS

Changes or additions to this agreement must be made in writing, signed by both parties and must be attached to this agreement.

PENNSYLVANIA ACT 153 *

This does not pertain to this event. ?All participants are 18 years of age or older. We have verified that all individuals involved have met ACT 153 requirements.

Camp, Clinic, and Community Service General Liability Insurance

INSURANCE *

I (renter) agree to supply Moravian College with a copy of our certificate of insurance.

* required field

Moravian College

Information

Moravian College Request for Facility Usage Form

Financial Agreements

Liability & Legal Agreements

Camp, Clinic, and Community Service General Liability Insurance