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2. Dorothy Hart Community Center Rental Request Form

4. Read our Dorothy Hart Community Center Rental Information (PDF) before completing the below rental request.

6. Rental Representative
8. Name*
9. Phone*
11. Address*
13. City*
14. State*
15. Zip*
17. Organization (if applicable)
19. Email Address*
21. Rental Information
23. Room Requested (choose one)*

    1. Auditorium
    2. Kitchen

    1. Room 1
    2. Room 2

    1. Room 3
25. Contact Person the Day of the Rental*
26. Contact Phone Number the Day of the Rental*
28. Date of Rental*
    Date of Rental
29. Type of Rental/Event*
31. Time (i.e., 9am-1pm) including Set up and Cleanup*
33. Number of Tables Needed*
34. Number of Chairs Needed*
36. Number of People Attending*
38. Equipment being brought/used

40. In consideration for the use of City of Fredericksburg, VA property for myself and all my legal representatives, I do hereby agree and undertake to save and hold harmless, release and forever discharge the City of Fredericksburg, its officers, agents, employees and any and all other persons, firms and corporations, acting on behalf of the City from any and all actions, demands or claims for damages to persons or property, that may arise out of the use of said City property specified here, without regard to a negligent act or omission of the applicant, the City of Fredericksburg, or any other person, organization , firm, or corporation acting on behalf of the City.

    By my signature below, I certify that I have received a copy of, read, and fully understand my rental contract, the general rental policies, and the prescribed responsibilities for DHCC lessees. I further understand that my failure to meet any of these responsibilities or comply with any policy may result in the immediate termination of the rental agreement by the onsite facility supervisor. I also agree that, if termination of the rental agreement is deemed necessary by the supervisor, I will ask that my guests exit the DHCC in a quick and orderly fashion and personally oversee the clean-up of the rental space. Finally, I understand and agree that, should early termination of my rental contract become necessary, I will receive no refund of rental fees and my deposit may be withheld.

    Applicant has read and will abide by attached DHCC Rental Policy.

42. Lessee Signature: I understand that checking the box below is the equivalent of signing my name.*

    1. I Accept
44. First and Last Name*
45. Date*
    Date
49. Alcohol Policy and Contract

    A. Lessee is responsible to obtain all necessary, banquet special event or mixed beverage special event licensing from the Virginia ABC Board. Here: (http://www.abc.virginia.gov/licensing/obtainlicense.html)

    B. Lessee of the DHCC with alcohol permit is required to be covered by additional comprehensive liability special event policy in the amount of $1,000,000.00 in effect the dates of facility use listing the City of Fredericksburg as the named insured, which is to be submitted to the office 2 weeks prior to rental. Which can be purchased here: http://www.specialeventinsurance.com

    C. Lessee is required to pay an additional alcohol deposit to the current rental deposit fees. These deposits are refundable provided there is no damage and the area is returned clean.

    D. Lessee will pay an alcohol usage fee. This will cover any additional administrative time required to track permitting and scheduling, which is to be submitted to the office no later than two (2) weeks prior to rental.

    E. Alcohol will only be consumed in the rental area (DHCC) that is covered by the ABC permit. No alcohol will be permitted outside the rental area.

    F. Alcohol usages fees are NOT refundable even if all other fees are refundable. (i.e. cancellation)

    G. Lessee assumes responsibility for all guests that consume alcohol during their event.

    In consideration for the use of City of Fredericksburg, VA property for myself and all my legal representatives, I do hereby agree and undertake to save and hold harmless, release and forever discharge the City of Fredericksburg, its officers, agents, employees and any and all other persons, firms and corporations, acting on behalf of the City from any and all actions, demands or claims for damages to persons or property, that may arise out of the use of said City property specified here, without regard to a negligent act or omission of the applicant, the City of Fredericksburg, or any other person, organization, firm, or corporation acting on behalf of the City.

    By my signature below, I certify that I have received a copy of, read, and fully understand the alcohol policy and contract for DHCC rentals. I further understand that my failure to meet any of these responsibilities or comply with the policy may result in the immediate termination of the rental agreement by the onsite facility supervisor. I also agree that, if termination of the rental agreement is deemed necessary by the supervisor, I will ask that my guests exit the DHCC in a quick and orderly fashion and personally oversee the clean-up of the rental space. Finally, I understand and agree that, should early termination of my rental contract become necessary, I will receive no refund of alcohol fees and my deposit may be withheld.

51. First and Last Name
52. Date
    Date
54. Please initial the following statements

    I have read and I understand the contract for renting a room in the Dorothy Hart Community Center.

56. Full payment is due 30 days prior to the event date.*
58. I understand that my rental time includes set-up and clean-up, and that I am responsible for setting up and taking down tables and chairs used at my event.*
60. I understand that my guests must enter and exit through the front main door (located on Canal Street). I will not prop open side doors during rental.*
62. I understand that I am responsible for cleaning the rented room, including wiping down tables, chairs and counter tops along with sweeping/mopping the floors.*
64. I understand that music has to be turned off by 10:30pm and failure to do so may result in the loss of my deposit.*
66. I understand that the contact person for the rental must check in and out with staff at the beginning of the event. (This is done to help the staff person know who the person is that they need to address regarding the rental.)*
68. I understand all of the rental rules and policies and I understand that not following any of them can result in my deposit being forfeited and the possibility of my not being able to rent in the future.*
70. I am aware that closures and cancellations at the Dorothy Hart Community Center will be sent out via www.Fredericksburgalerts.com.*
72. I understand that any changes to the rental contract must be done in writing and turned into the Dorothy Hart Community Center two (2) weeks prior to the event, either via email or in person.*
74. In order for deposit refunds to be granted, a Clean-Up Verification must be signed by the Renter and Site Supervisor. Any room issues must be listed at that time.*
76. I have no questions about the rental contract.*
Leave This Blank:


78. 1. Receive an email copy of this form.
79. Email address

    This field is not part of the form submission.

80. Submit Submit and Print

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