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2. Name of Event:
4. Type of Event:
6. Date(s) and Time(s)
   Date(s) and Time(s) Start Date

   Date(s) and Time(s) Start Time

   —

   Date(s) and Time(s) End Date

   Date(s) and Time(s) End Time
8. Name
9. Email Address
11. Address
13. City
14. State
15. Zip Code
17. Phone Number
19. Sponsor/ Organization:
21. Approximate Attendees:
23. INDEMNIFICATION AGREEMENT:

    RENTER AGREES THAT AS PART OF THE TERMS OF THIS AGREEMENT, RENTER ON BEHALF OF HIMSELF/HERSELF/ITSELF AND HIS/HER/ITS GUESTS, HEIRS, BENEFICIARIES, EXECUTORS, ADMINISTRATORS, INVITEES, ASSIGNS, LEGAL REPRESENTATIVES, AND ANY PERSON PRESENT AT THE FACILITY AS A RESULT OF RENTER’S EVENT AGREES TO DEFEND, INDEMNIFY AND HOLD HARMLESS THE CITY OF FERNDALE AND ITS APPOINTED AND ELECTED OFFICIALS, OFFICERS, REPRESENTATIVES, AUTHORIZED REPRESENTATIVES, EMPLOYEES AND AGENTS FROM ANY AND ALL DAMAGES, LOSS, COSTS, CLAIMS, AND EXPENSE OR LAWSUITS FOR DAMAGES OR LIABILITY, INCLUDING ATTORNEY FEES IN DEFENSE THEREOF FROM PERSONAL OR BODILY INJURY, INCLUDING DEATH AT ANY TIME RESULTING THEREFROM, SUSTAINED OR ALLGED TO HAVE BEEN SUSTAINED BY ANY PERSON OR PERSONS ON ACCOUNT OF DAMAGE TO PROPERTY, ARISING OR ALLEGED TO HAVE ARISEN DIRECTLY OR INDIRECTLY OUT OF OR IN CONSEQUENCE OF THE RENTAL OF THE FACILITY AS PER THIS AGREEMENT.

    USER AGREES BY HIS/HER/THERE SIGNTURE ON THE FACE HEREOF THAT HE/SHE/THEY HAS READ AND IS AWARE OF THE TERMS AND CONDITIONS CONCERNING THE USE OF THE FACILITY AND ACCEPTS FULL RESPONSIBILTY HEREIN.

25. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
27. Electronic Signature
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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field