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Moravian College Request for Facility Usage Form

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 *

  Johnston Hall Court
  Johnston Hall Classroom
  Johnston Hall Conference Room
  Movement Room
  Dance Studio
  ARC - all 4 courts and track
  ARC Court 1
  ARC Court 2
  ARC Court 3
  ARC Court 4
  ARC Lobby
  Betty Prince Field
  Makuvek Field - Soccer, Field Hockey, Lacrosse Field
  Gillespie Field - Baseball Field
  Hoffman Cours - Tennis Courts
  Blue and Grey Field - Softball Field
  Grass FIeld
  Calvo Field - Football Field
  Breidegam Track
  Track Throwing Area
  Stadium Building
  Blue and Grey Pavilion

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. *

Please refer to the attached information sheet for contact information for each of these departments.

  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 *

If you answer, 2, 3 or 5, Click on Not Applicable for each question up to the final quesion on Camp, Clinic, and Community Service General Liability Insurance

  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 *

A site manager is required for all outside groups using Moravian College facilities. The cost for this service is $30.00 per hour.

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

Billing *

Renter will be expected to pay for any and all fees and expenses that are incurred by the College as a result of this event in advance. Renter will be billed after the conclusion of the event when additional charges have accrued. Remittance shall be by check made payable to ?Moravian College? and mailed to the: Athletic Office Moravian College Johnston Hall 1200 Main Street Bethlehem, PA 18018 Payments are due within 30 days of the billed date. Any balance due and owing after 30 days of the billed date will be subject to interest at a rate of 12% per annum until payment is made in full.

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

INDEMNIFICATION *

In consideration of the use of premises or facilities owned or operated by Moravian College and/or in consideration of permitting Renter to participate in the activity listed above, Renter hereby agrees to indemnify and hold harmless Moravian College, it?s agents, servants, and employees from and against any and all loss, damage, liability or expense, including attorney?s fees, including but not limited to all claims for damages on account of or by reason of bodily injury, including death, which may be sustained or claimed to be sustained by any person, and all damages to property, caused by or arising out of or claimed to have been caused by or to have arisen out of the Renter?s activity under this contract.

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

FAILURE TO PAY *

In the event suit or action is instituted to enforce compliance with this Agreement, including but not limited to the collection of any sums due and owing, the College shall be entitled to reasonable attorney?s fees and expenses in such action all together with court costs.

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

DAMAGES *

Renter will not do, nor permit to be done, any injury or damage to any part of previously said facilities. Further, Renter agrees to reimburse the replacement value of said facilities to the College for any College property that is in any way injured, marred, or defaced, as a result of Renter?s presence on or use of College facilities. It is further agreed that no decorative or other materials shall be nailed, tacked, screwed, taped, or otherwise physically attached to any part of buildings or furnishings without the prior consent of the College. Renter also agrees not to make any alterations of any kind to said building or equipment contained therein. Renter will post any signs, cards, or posters only upon such display areas as the College may designate. All material is subject to approval of the College. Any repairs needed for damage done to the premises by the Renter, or by any person who may be in or upon the premises under the Renter?s direction, shall be performed by the College and paid for by the Renter. Such payment shall be made within then days of receipt of the billing by the College for damages. The Renter also agrees to accept the Colleges assessment of damages

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

STATEMENT OF ACCOUNTING *

If this is a Moravian College fundraiser a financial statement must accompany the deposits showing all income and expenses. Please use the attached forms.

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

CANCELLATION *

A $100.00 deposit must accompany the returned signature page of the rental agreement. This deposit will be put towards the rental fee. Should the renter cancel the event the deposit is non-refundable. In the event Moravian College needs to cancel the event the deposit will be refunded. The renter agrees to also pay any expenses incurred by the college in connection with the event covered in this agreement, including, but not limited to, the cost of making refunds to patrons.

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

Liability & Legal Agreements

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

If this is a Moravian College sponsored event a completed waiver forms for ALL attendees, must be presented to the Moravian College site supervisor BEFORE the activity can begin. If a particular attendee does not have this waiver form completed, they will NOT be permitted to join the group for said activity.

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

MEDICAL COVERAGE *

Any camp / clinic / event held on Moravian College?s campus and involving physical activity must have an athletic trainer present. The athletic trainer must be in good standing and hold a current license to practice athletic training in the state of Pennsylvania. The athletic trainer must also be working under the direction of a physician and have a written supervising physician agreement. Any deviation from the above must be approved by the Moravian College Athletic Department.

  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 *

In the event the Renter defaults in the performance of any term or condition of this agreement, the College may elect to serve notice to vacate or cancel the contract before the event. A revocation of the Renter granted hereby shall not reduce any of the fees and cost agreed to be paid by the Renter hereunder and all charges shall be paid in accordance BILLING hereof. The College may revoke the license granted hereby for any of the following reasons: a. Sale or possession of alcohol, illegal drugs, restricted illegal drugs, or narcotics, except where lawfully prescribed for medical or dental care. b. Possession of firearms, weapons, ammunition, fireworks, or explosives. c. Misuse, abuse, theft, or destruction of the College property. d. Behavior, that in the opinion of the College is irresponsible or dangerous to persons or property.

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 *

To insure Moravian College is abiding by the Pennsylvania Act 153, please indicate that those associated with your organization who will be involved in this event have proof of the mandated clearances which include: a) Pennsylvania State Police Criminal History Record Information b) Child Abuse History to determine if the person is named as a perpetrator of an indicated or founded child abuse report c) Federal Criminal History Background Check (FBI check with submission of fingerprints)

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 *

Renter shall provide Moravian College with a standard ACORD Certificate of Insurance evidencing Commercial General Liability at the minimum limits of $1,000,000 per occurrence and $1,000,000 aggregate, Combined Single Limit of coverage. Moravian College shall be named as ?Additional Insured? on all insurance policies for the above listed event. Such certificate shall also contain the following statement or its substantial equivalent: ?The insurance covered by this certificate will not be cancelled or materially altered except after 30 days written notice has been received by Moravian College.? A copy of the Certificate of Insurance must be received in this office at least three weeks prior to the event.

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

* = required field

Moravian College

Wed, 10/18 | Women's Soccer at Ursinus College L, 1-0 (Final) RC | BX
Wed, 10/18 | Field Hockey vs. Muhlenberg College L, 5-0 (Final) PH | RC | BX | V
Wed, 10/18 | Men's Soccer at New Jersey City University W, 2-1 (Final) RC | BX
Tue, 10/17 | Women's Volleyball at Montclair State University W, 3-2 (Final) BX | RC
Mon, 10/16 | Golf Franklin & Marshall College Fall Invitational 12th of 15 R | RC
Sat, 10/14 | Women's Volleyball vs. Susquehanna University L, 3-1 (Final) V | BX | RC | PH
Sat, 10/14 | Men's Soccer at The Catholic University of America L, 2-1 (Final) BX | RC
Sat, 10/14 | Field Hockey vs. The Catholic University of America L, 4-1 (Final) V | BX | RC | PH
Sat, 10/14 | Women's Soccer at The Catholic University of America L, 1-0 (Final) BX | RC
Sat, 10/14 | Women's Volleyball vs. The University of Scranton L, 3-0 (Final) V | BX | RC | BX | PH