Facility Usage Form Written by Coughlin Printing on May 31, 2022. Posted in Uncategorized. Facility Usage FeesFirst NameLast NameToday's DateDate(s) RequestedFacility RequestedInformation About Your GroupName of Organization or IndividualTime from:Time to:Supervisor in ChargeMailing AddressTelephone NumberInformation About Your Intended Use of FacilitiesPurpose of UseTotal Participants ExpectedAdultsChildrenIs Material or equipment from the facility required?YesNoIf needed, state what equipment and its purposeAdmission Fee Charged?YesNoIf yes, what will the proceeds be used for?AgreementThe undersigned is over 21 years of age and has read this form and attached regulations and agrees to comply with them. He/She agrees to be responsible to the municipality for the use and care of the facilities. He/She on behalf of:First NameLast Namedoes hereby covenant and agree to defend, indemnify, and hold harmless the Town of Forestport from and against any and all liability, loss, damages, claims, or actions (including costs and attorney fees) for bodily injury and/or property damage, to the extent permissable by law, arising out of or in connection with the actual or proposed us of the Town of Forestport's Property, facilities, and services by:Signature Here:Submit Previous Next