Rental Agreement Waiver by nja90133

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									                 Glade Run United Presbyterian Church
                1091 Pittsburgh Road     Valencia, PA 16059
               724-898-3503      gladerun@gladerunchurch.org


                     BUILDING USE AGREEMENT AND
                          WAIVER OF LIABILITY


Personal Name or Name of
Group____________________________________________________________

Authorized Signatory_________________________________________________

Address___________________________________________________________

Phone____________________________________________________________
      Home                   Cell                    Work

Date / Time of Event_________________________________________________

Room/Rooms to be used_____________________________________________

Nature of event_____________________________________________________

Number Expected__________            Number of Adult Supervisors__________
                                          (if needed)


_________________________________________________________________




By signing this Building Use Agreement and Waiver of Liability:
I acknowledge receipt of the Glade Run Site Regulations and Fee Schedule
document;
I agree to abide by the terms and conditions as set forth in the Glade Run
Site Regulations and Fee Schedule document;
I affirm that the group that I represent will not hold Glade Run Church, its
offices, staff or members responsible for any accident or injury incurred by
any member of said group while participating in the above event;
I affirm that all information represented above is submitted in truth to the
best of my knowledge.

Signed: ___________________________________________________________
Title: _____________________________________________________________
Date:____________________________________________

								
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