Name of Facility: 

Address:

Location/Driving Directions

Contact Person Name, Title & Phone #:

Facility Phone #:

Description of Facility: 

Meeting room(s): # Occupants ___, tables # ___, chairs # ___,

audio visual equipment = white board ___, screen ___, slide projector ___, TV – VHS ___, TV – DVD ___,  other ________________, microphone ___

Kitchen – stainless steel equipment ___, MDH inspected & approved ___, stove ___, oven ___, microwave ___, dishwasher ___, refrigerator ___, utensils ___,

cookware ____, dishware _____, serving dishes ___, coffee pot ___

Dining Room – size ___, tables #___, chairs # ___, audio visual (white board, screen,

slide projector, TV – VHS, TV – DVD, other ____________________, microphone _____

Gymnasium – size (full court or half court) _____, bleachers ____, chairs ___,

equipment (basketball hoops, balls, volley ball poles & nets, padded mats, etc. _________,Dressing room ___, showers ___

Auditorium/theatre – stage size ___, dressing room (s) # ___, seats or chairs # ___,

sound system ___, lights ___, rigging ___, Microphone ___, stands ___

Other – swimming pool ___, ice rink ___, fields for various sports _______________,

tennis courts ___, bike/hike trails _________, playground ___, park ___, pavilion ___,

picnic tables ___, skateboarding ___, fishing dock/pier ___, public access to lake ___,

boat launch/ramp ___, beach ___, lifeguard ___, outdoor bathrooms ___,

office, additional features or comments __________________________________________

Days of Operation:

Hours:

Fees (Profit Rate & Non- Profit Rate)

Hourly $____, daily $ ___, trash removal $___, cleaning $ ___, other - ______$___

Current Uses/Users:

Preference Given to: