Facilities Use Request - FUR - 4-H - PLACER - COUNTYWIDE EVENTS

Facilities Use Request Form for
Clubs and COUNTYWIDE EVENTS

Before the event can be posted on the website or included in the newsletter the following information MUST be given to the 4-H office.

If Planning a club meeting or a project meeting, please use the
Placer County 4-H Facilities Use Agreement Request: MEETINGS Club project

Follow the steps below to secure a facility:

You will need that information to fill out the survey

1/ Contact the facility you wish to use.
2/ Ask them to hold the date(s).
3/ Determine cost.
4/ Is a Certificate of Insurance required?
5/ Do they have their own contract or application?

✻ = Required

Allow a MINIMUM of 10-14 days for the processing of any additional dates and times for existing insurance agreements.

NEW AGREEMENTS may take longer.

Event Title: ✻

Event Date: ✻

Event Start Time: ✻

Event End Time: ✻

Club/Program Name: ✻

Event Contact Person: ✻

Event Contact person E-MAIL: ✻

Contact Person Phone: ✻

Do you want your phone published for the event contact: ✻

Yes No

FACILITY INFORMATION

DO NOT SIGN CONTRACTS or APPLICATIONS

If either is required, the contract or application is with "The Regents of the University of California C/O Cooperative Extension Placer Nevada".

It must be reviewed and signed by the County Director.

If you sign a contract or application you are personally responsible, not the University.

Submit contract(s) by uploading them at the bottom of this form.

Does this facility have its own Facility Use Agreement or Rental contract: ✻

Yes No Not sure

Does this facility require a Certificate of Self-Insurance Coverage? ✻

Yes No Not sure

Facility/Agency Name: ✻

Facility Physical Address: ✻

City/Zip ✻

Facility Mailing Address (If different from physical):

Facility Contact Person Name: ✻

Facility Contact Phone: ✻

Facility Contact E-MAIL: ✻

EVENT INFORMATION

THE FOLLOWING INFORMATION IS OFTEN REQUIRED BY FACILITIES.

Is the event open to the public ✻

Yes No

Will an admission fee be charged? ✻

Yes No

Approximately how many adults are expected? ✻

Approximately how many youth are expended ✻

Room(s) requested: (include kitchen if needed) ✻

Event Set-Up Time: ✻

Event Departure Time (after clean-up): ✻

On-Site furniture/equipment needed (Chairs, Tables, PA system, etc.) ✻

Will you need the facility to set-up any equipment? ✻

Yes No

If YES, please specify:

Will you be serving food at the event? ✻

Yes No

If YES, please mark all that apply:

Prepackaged Prepared in advance Prepared on-site

If Prepared on-site, please describe what you will be serving:

ADDITIONAL INFORMATION about the EVENT

Is Registration required? ✻

Yes No

If YES, please specify DUE DATE:

If YES, Please specify location to submit registration (On-line, 4-H Office, other)

Registration/Participation Fee (if a fee, please specify) ✻

Will there be a fundraiser at this event: ✻

Yes No

If YES, 4-H Office approval is REQUIRED BEFORE advertising the event.

Have you already submitted FORM 8.7 to the 4-H office? ✻

Yes No

Please provide basic information about this event, such as activities, speakers, participants, topics, etc. (This information will be used in the newsletter and website if applicable)

Any additional registration form(s)/packet(s0 will need to be submitted to the 4-H office for approval and required additions by UC Cooperative Extension. If you provide the needed information, the 4-H office can format them for your event.

Would you need to have a registration form/packet posted to the website for members to download?

Yes No

Submitted by and Date: ✻

Additional notes:

If you have a contract, agreement and/or application to submit, please use the upload option below. Thank you.

Upload your file(s)

Facilities Use Request - FUR - 4-H - PLACER - COUNTYWIDE EVENTS

Facilities Use Request Form for Clubs and COUNTYWIDE EVENTS

Follow the steps below to secure a facility:

1/ Contact the facility you wish to use.2/ Ask them to hold the date(s).3/ Determine cost.4/ Is a Certificate of Insurance required?5/ Do they have their own contract or application?

Allow a MINIMUM of 10-14 days for the processing of any additional dates and times for existing insurance agreements.

** NEW AGREEMENTS may take longer.**

FACILITY INFORMATION

** DO NOT SIGN CONTRACTS or APPLICATIONS **

If either is required, the contract or application is with "The Regents of the University of California C/O Cooperative Extension Placer Nevada".

It must be reviewed and signed by the County Director.

If you sign a contract or application you are personally responsible, not the University.

Submit contract(s) by uploading them at the bottom of this form.

EVENT INFORMATION

THE FOLLOWING INFORMATION IS OFTEN REQUIRED BY FACILITIES.

ADDITIONAL INFORMATION about the EVENT

If you have a contract, agreement and/or application to submit, please use the upload option below. Thank you.

Facilities Use Request Form for
Clubs and COUNTYWIDE EVENTS

1/ Contact the facility you wish to use.
2/ Ask them to hold the date(s).
3/ Determine cost.
4/ Is a Certificate of Insurance required?
5/ Do they have their own contract or application?

NEW AGREEMENTS may take longer.

DO NOT SIGN CONTRACTS or APPLICATIONS