ADIC Club Rental Form

Facilities Use Agreement

Please review all rules and regulations regarding your use permit for rental of the Almonte Club House. Failure to comply may result in revocation.

Be precise about your type of activities and times of use. Misrepresentation will result in forfeiture of deposit.

The Almonte District Improvement Club reserves the right to terminate use permit at any time.

Organization*
Contact Person*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Driver's License*
Rental Date*
MM slash DD slash YYYY
Time In*

: Hours

Minutes

AM/PM
Time Out

: Hours

Minutes

AM/PM
Multi Day Rental Request
Please provide additional detail if you want to rent on multiple days and times.
Total Hours*
Please enter a number from 2 to 12.
Charging Admission?*
- Yes
- No
Estimated Attendance*
Please enter a number from 1 to 50.
Percentage of Adults to Minors*
Type of Activity*
Requirements
- Tables
- Chairs
- Kitchen
- Music
- Patio
- Garden
- Decorations
Other Requirements / Additional Detail
Alcohol is prohibited at the Clubhouse and surroundings unless acceptable private event insurance is obtained.*
- I agree to the no alcohol policy
- I would like to offer alcohol at my event and will present proof of private event insurance.
RENTAL CONDITIONS AND REQUIREMENTS FOR THE ALMONTE CLUBHOUSE*
- I have read and agree to the RENTAL CONDITIONS AND REQUIREMENTS FOR THE ALMONTE CLUBHOUSE
RENTAL CONDITIONS AND REQUIREMENTS FOR THE ALMONTE CLUBHOUSE
ADIC Waiver and Release of Liability*
- I have read and agree to the Almonte Waiver and Release of Liability.
Cleaning Rules*
- I have read and agree to the Cleaning Rules
CAPTCHA

Mail three checks to: Deborah Graham
P.O.Box 443
Mill Valley, CA 94942

Three checks:

1. Rental check made payable to ADIC

2. Damages / Security check payable to ADIC ($200)

3.Cleaning check payable to Deborah Graham( $100)