Chapter Five:  Fiscal Affairs

Procedure Title:  Facility Request Form - Organization/Individual
Based on:  Board Policies Nos. 2 and 7
Procedure Number:  5.05b
Date Adopted/Revised:  June 25, 2001; September 14, 2005; November 21, 2006; May 15, 2007; July 22, 2016

Non-profit organizations may use the facilities at no charge.  For profit organizations will be charged a usage fee.  All organizations will be subject to special fees such as, but not limited to, setup/tear down, security, hosting, and computer access.  Fees are available in the Office of Fiscal Affairs.  In some cases, liability insurance coverage may be required.

Facility request forms are on the following pages.

South Arkansas Community College
Facilities Use for Organizations
Request and Release of Liability Form



Facilities
Requested:__________________________________________________

Date of Request:_____________________________________________________

Person Making Request:__________________Title: ___________________

Phone Number:  Office: _________________ Home: ___________________

Date(S) Facilities Desired:______________________________________________________ 

Hours from _________________________ To ________________________

Activity Planned:______________________________________________________

____________________________________________________________

We understand that South Arkansas Community College does not provide medical or any other insurance coverage for any accident that occurs while we are using the College’s facilities.  We also understand that the College does not accept liability for any such accident and it is the responsibility of our organization and/or individuals to provide insurance coverage for such accidents.  We have also read the rules and guidelines for facilities use and will abide by them.  The undersigned, individually, and as the authorized agent of the named organization covenants with South Arkansas Community College to never institute suit or action against South Arkansas Community College or any agent or employee of the College and further agree to indemnify and hold the College and its agents and employees harmless from any loss, payment or expense by reason of any claim I may have or any person using the College’s facilities pursuant to this request may have or hereafter acquire in using or occupying the South Arkansas Community College facilities.

Name   _____________________________   Position   ____________________
PLEASE PRINT

Signature

_____________________________________________________________

For (organization making the request)

______________________________________
South Arkansas Community College
Facilities Use for Individuals
Request and Release of Liability Form



Facilities Requested:_____________________________________________________

Date of Request:_______________________________________________________

Person Making Request:_________________________Title:__________________________

Phone Number:  Office:____________________Home:__________________

Date(S) Facilities Desired:______________________________________________________ 

Hours from _________________________ To ________________________

Activity Planned:______________________________________________________

_____________________________________________________________


I, the undersigned individual, in order to utilize the South Arkansas community College facilities’ covenant with the College to never institute suit or action against South Arkansas Community College or any agent or employee of the College and further agree to indemnify and hold the College and its agents and employees harmless from any loss, payment or expense by reason of any claim I may have or any person using the College’s facilities pursuant to this request may have or hereafter acquire in using or occupying the South Arkansas Community College facilities.  I understand that South Arkansas Community College does not provide medical or any other insurance coverage for any accident that occurs while I am using the College facilities.  I also understand that the College does not accept liability for any such accident and it is the responsibility of any individual to provide insurance coverage for such accidents.  I have read the rules and guidelines for College facilities use and will abide by them.


Name   _____________________________  Signature: __________________
PLEASE PRINT

Address_________________________________________________________


Phone Number: Office:________________ Home:________________________


Date: _________________