ࡱ> npm5@ Lbjbj22 &VXX::::jjj8\4:>V"MF3H3H3H3/w34649$X<R>|:#YM##::::&&&#4:RF3&#F3& &'r1T"22 OOj#*234:0:82&?$8&?2::::&?2<]N&  ::D d& The Jones House Community and Cultural Center 604 West King Street Boone, North Carolina 28607 (828) 262-4576 Phone (828) 262-4599 Fax  HYPERLINK "mailto:wcac@boone.net" wcac@boone.net  Property and Grounds Event Usage Form Note: This form is for public use of the Jones House Community Center property and grounds and is to be completed for all organized events occurring in the grounds of the Jones House Community Center. If the planned event involves the interior of the building, a separate event form should be used for that portion of the activities and both forms should be filed together. All organized events occurring on the Jones House Community Center properties must be pre-approved, all required attachments must be provided, and this form signed in advance by the Executive Director. Instructions: fill in grey-shaded fields using Microsoft Word. Event  FORMTEXT       Group Sponsoring Event Event Date  FORMTEXT       Scheduled Times: Setup  FORMTEXT       Event Begins  FORMTEXT       Event Ends  FORMTEXT       Cleanup  FORMTEXT       Contact Person  FORMTEXT       Email  FORMTEXT       Telephone Number (day)  FORMTEXT       (night)  FORMTEXT       Title and Functional Responsibility with Regard to Event  FORMTEXT       Will this person be present at all times during the event?  FORMTEXT       If not, who will be present and in charge during the event?  FORMTEXT       Organizing Person(s) (if not the contact person listed)  FORMTEXT        Estimated Number of Participants  FORMTEXT       Estimated Number of Volunteers  FORMTEXT       On the reverse side, please list all participants involved in any way with the proposed event. Include name, address, telephone numbers. Also include professional event organizers, event promoters, financial underwriters, commercial sponsors, and charitable agencies for whose benefit the event is being produced, the organization(s) in whose name the event Is being promoted, and all others administratively, financially, and organizationally involved as principals in the production of the proposed event.  If there will be music, sound amplification, or any other noise impact, please describe:  FORMTEXT       The sound equipment of the Jones House Community Center may only be set up and operated by pre-approved persons who are appointed by the Executive Director. If these services are requested, the hourly fee must be paid directly to the appointed sound technician at the end of the event. The Jones House equipment is capable of playing a single CD or an audio-tape. Will you need sound equipment?  FORMTEXT       What time will this need to be set up?  FORMTEXT       How long will you need the sound equipment?  FORMTEXT       How many microphones will be needed?  FORMTEXT       Do you plan to use a CD or an audio-tape?  FORMTEXT       Contact Person for Sound Needs  FORMTEXT       Phone (day)  FORMTEXT       (night)  FORMTEXT        Are you planning to accept any donations while using the Jones House Property?  FORMTEXT       For What Purpose?  FORMTEXT       No admission fees may be charged. Collection of donations must have prior written approval of the Executive Director. The sale of any item must be pre-approved by the Executive Director and may not, in any event, be sold for commercial purposes. Equipment Needs: (Event planners are responsible for moving equipment in and out of the building and will be held financially responsible for any loss or damages. All equipment shall be returned to its original location.) Podium  FORMTEXT       Chairs (specify number)  FORMTEXT       4 Tables (specify number)  FORMTEXT       6 Tables (specify number)  FORMTEXT       8 Tables (specify number)  FORMTEXT       I agree that I am responsible for any damages or losses occ  >?op޾xeXLGA hp|CJ h,5h,0J5B*phh,0J5:B*ph$j#h,5:B*Uphh,5B*phjh,5:B*Uphh,5:B*ph h,5:h,5:CJOJQJh,5:CJ OJQJh,5:CJ(OJQJjh,Uhp|5CJOJQJh,5CJOJQJ hp|5hp|jhp|UmHnHu !?Tp$dh$Ifa$gd,l$$Ifa$gd,l h $Ifgd,l h gd, hBBL  C D  @ zxxrrrrrriidh^^ h gd,zkd$$Ifl0h *  t0644 la      C D < > @ ˾҃{sgsUgIg{s=h)hp|5OJQJjh 0OJQJU#jFh)h 0OJQJUjh)OJQJUh)OJQJhp|OJQJhp|CJOJQJh 0h 0CJOJQJ]^J&h 0h 05CJOJQJ\^JaJh 06CJOJQJ]hp|6CJOJQJ] h,h,hp|CJOJQJhp|5CJOJQJ\hp|5CJOJQJ\ hp|CJ$hp|@ V X l n p z |     . 0 D F H R T d f h | ~ xphOJQJ#jh)h 0OJQJU#jh)h 0OJQJU#jh)h 0OJQJU#j.h)h 0OJQJU"jh)OJQJUmHnHu#jh)h 0OJQJUh)OJQJjh)OJQJUhp|OJQJ)@ ~ <z^d^d^^dh^  <>@TVXbdxz*,.8:󿩥ynjh 0UjZh 0UjhUmHnHujh 0UjhUhhp|#jrhh 0OJQJUhp|OJQJ"jhOJQJUmHnHu#jhh 0OJQJUhOJQJjhOJQJU(RThjlvxZ\prt~ڲ֧֖졅ڡ{u hCJjhCJU jhp|5>*UmHnHujh 0U hp|CJjh 0Ujhp|UmHnHuj2h 0Ujh 0Uhhp|jhUmHnHujhUjFh 0U)  Z\^rtv VXlŷŭqŭŷ]ŷ'jhh 0CJOJQJU'jhh 0CJOJQJU&jhCJOJQJUmHnHu'j hh 0CJOJQJUhCJOJQJjhCJOJQJUhp|CJOJQJ hp|CJjhCJUmHnHujhCJUjhh 0CJU"lnpz|>@BVXZdfݿݿݵsaOa#jhh 0OJQJU"jhOJQJUmHnHu#jXhh 0OJQJUjhOJQJUhOJQJhp|OJQJ'jhh 0CJOJQJUhp|CJOJQJhCJOJQJ&jhCJOJQJUmHnHujhCJOJQJU'jlhh 0CJOJQJU  𳥳xrir`rhp|6CJ]hp|5CJ\ hp|CJ#j0hh 0OJQJUhp|>*OJQJ#jhh 0OJQJUjhp|UmHnHuhp|5>*CJOJQJ"jhOJQJUmHnHu#jDhh 0OJQJUjhOJQJUhp|OJQJhOJQJ#h<=X?@@ @AA\B^BdBfBhBzB|Bh]h&`#$^dh^ & F & Fdh^  >@BVXZdfhj$&^`tvxɨxthp|j~ hh 0CJUj hh 0CJUjhh 0CJU jhp|5>*UmHnHujhh 0CJU hp|CJjhCJUmHnHujhh 0CJU hCJjhCJU*urring while the participants in this event are using the property. I agree to pay a sound technician appointed by the Executive Director if the Jones House Community Center Sound System is used. I agree that I will be responsible for obtaining any necessary permits from the Boone Town Clerk and for notifying the Boone Police Department of any event which would involve leaving the grounds (for example, a walk or march). Signature ___________________________________ Position ______________________ Date______________  All planned events taking place on the Jones House Community Center property and grounds must be approved in advance by the Executive Director and the date of approval indicated below: Executive Director s Signature _______________________________________________ Date_______________  PAGE  PAGE 2 For Office Use: Deposit Paid _____________________ Received by _________________________________________ Date _______________________________ Assigned Sound Technician __________________________________________________________________________________________________ Assigned Staff Person _______________________________________________________________________________________________________ Attach the Following to the Form and File in Jones House Usage Notebook: ____Hold Harmless Agreement (must be filed at least annually or whenever contact person changes) ____Copy of Building Usage form if building is to be unlocked during event ____Complete Schedule of Events (from setup through cleanup) with times and event details ____Copy of all applicable permits CONDITION of Grounds following Usage_________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ Staff Signature ______________________________________________________________________ Date Inspected __________________________ Deposit Refunded (amount)__________________________________ Date Refund Authorized to Town of Boone ____________________________ Notes:  <=T?X?l???@@@@ @AAAB>BXB\B^B`BbBdBfBhBjBvBxBzB~BBBBķ⷇Ī{rhbhbhbh hp|0Jjhp|0JUhp|5:CJhp|CJOJQJ^J*jhp|CJOJQJU^JmHnHuhp|5CJOJQJ^Jhp|CJOJQJ\^Jhp|5>*CJOJQJ(jhp|5>*OJQJUmHnHuhp|>*OJQJhp|OJQJhp| hp|CJUhp|CJOJQJ"|B~BBBBBBBBCCDDEENFGG^HHHIJKKLL$a$dhh]h&`#$BBBBBBBNFVFGGG^HHHLLLĺĺhp|5CJOJQJ^Jhp|5:CJhp|CJOJQJ^Jhp|CJOJQJhp|>*CJOJQJhp|5CJOJQJ\h3hp| hp|0Jjhp|0JUh30JmHnHuLLLLLdh^$a$$&P/R / =!h"h#$&%#Ddo qZ  C 6Ahouse_bw_smallbu<*jfwlB9ʃQD(nI<*jfwlB9ʃPNG  IHDR Jz PLTE̙333jbKGDH cmPPJCmp0712OmIDATXíTTվW\"PnZΠkhjeqLzzOu(f9="RUv!+ }-?,|{$_E**30BbSDMz%~(SE"_#dR d)gм܎S u[iRf]䬡k{H~xn,,F6T_h`Q UE2Ȝ}nt$ 8pmicԉ ͝ςϪ(`I $%ה -Ez=r&l̲5&!{(T_ދb}+"faPN{rC_oP^>@ֈWX0ٵgaG 9I e8uV9V@L6mf80H|hZfe%9|xuo5g8 Lz#\k2W?pQ%fM/oeBjFv1 d7}_ T#IãtI;9۾QWkf9bĨX#drG9KJ#bgΜ4/ԒPW,YO"zU-rгcFƌsd) (>lc{-U 7K$| A,Oŀ>U|B:)HLƹq雭NoyBbqZK0MT[X⚸d {0SςWѲ:}˚Hg4id8=kIWp+0uQ #}cUtua'r"7c =HS~ʖIV5'[4OڰUVZ)6kU \}?*Y[l+(>|,8WpmK"5X˜K*RM -9Z$=+]DF{U/ft^kD2:Y?E|a^f4wr.lvB<`hg%DE_)("t>'ԉ%2yCw=d_Vm KbN^vMO %Lm2kVٗ݁g%}(/ML&cr}UÓbv # -t[$1~i"wd!QbXBK[=nt3=1@o)bB:_^P&t#Y͌7urU$ee iqj_fWzerN=OV증 8:BRDW6l_O*;1D"-~G:l/ZѭE;vkʟV##Ƃ V8avW-!RxwwchԱ&xlXF]؁א !ta}ӕVkE[҉Q̿3[Np3KOljBKl]5ΜH(?7A\%uIhB %ǐ# K8nb$h[}2=ؔYN7 9D`i^d9(9uɭE7Ν@FgNuyg }fh!2kHY7YNЎR-{vjg-zu,-8 IޛZ !`ԍz}B=)I({Z%Xw^9DU1I lȚ}e35etSKwzwd/GJTݦEO3%g"9%2(o;Jx:I -{[緱r'ԵI g8on8{eN*p/FeQHQ|?Cpʥ )]" }ȂTLc\피IENDB`DyK wcac@boone.netyK ,mailto:wcac@boone.netb$$If!vh5 5#v #v:Vl t65 5atDText1tDText2tDText6tDText5tDText4tDText3tDText7tDText8tDText9vDText10vDText11vDText12vDText13vDText14vDText15vDText16vDText17vDText18vDText19vDText20vDText21vDText22vDText23vDText24vDText25vDText26vDText27vDText28vDText29vDText30vDText31vDText32H@H Normal5$7$8$9DH$_HmH sH tH J@J Heading 1$$@&a$5CJ OJQJDA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List 6U@6 Hyperlink >*B*ph:B@: Body Text CJOJQJRC@R Body Text Indentdh^OJQJZR@"Z Body Text Indent 2dh^ CJOJQJ\S@2\ Body Text Indent 3 ^CJOJQJ\^JLP@BL Body Text 2$a$5CJOJQJ^J4@R4 Header  !.)@a. 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