Special Use Authorization For
Submission Date: ______
This Special Use Authorization allows:
Group Represented: ______
Telephone Number: ______
For the purpose of: ______
On the following date(s): ______
Special conditions of use: ______
This Authorization is contingent upon the following conditions:
- The authorized User acknowledges that separate special use authorizations may be given by ChristIndependentMethodistChurch to others for use of this property during the same period prescribed by this authorization.
- User will prevent and prohibit damages to church property during the dates listed above.
- User will clean and restore church property to the original condition at the conclusion of the use. A SECURITY DEPOSIT OF: $______IS REQUIRED.
- User will repair any damage to church property resulting from the use during the dates listed above and expense for the repair shall be born by User.
- User agrees that nothing under the terms of this authorization or any use contemplated under this authorization shall render the Church liable for property or personal damages resulting from the use. The User, its successors, assigns, members, heirs, executors, and administrators, do hereby agree to indemnify and hold harmless the Church for any bodily or personal injuries, claims of negligence, property damage or loss, and all other causes of action in lay whatsoever attributable to activities of User or any of its members. User understands that this waiver includes any claims based on partial or sole negligence, action or inaction of User, his or her employees, representatives, successors and assigns, and includes any claims based on partial or sole negligence, action or inaction of the Church, its officers, employees, agents, representatives, successor and assigns.
- Proof of a policy of liability and property insurance covering personal injury and property damage in the amount of $______shall be presented to the Church before this agreement becomes effective. (This condition may be waived upon Board approval)
- This authorization is revocable at will.
- The authorized User agrees that no activity will be done on church property on Sunday or Holidays. (This condition may be waived upon Board approval)
I agree to the conditions of this authorization, and I am an authorized representative of User’s organization.
Special conditions waived, if any: ______
Authorization based on conditions above is approved.
Approved By: ______Date ______
Board Approval Date: ______