Facility Use Request Form Supplemental Page



Facility Use - Supplemental FormCrossroads Community CenterSPACE & USE1. Indicate how you will use the space (mark all that apply): FORMCHECKBOX Meeting FORMCHECKBOX Class FORMCHECKBOX Reception FORMCHECKBOX Party FORMCHECKBOX Adults only FORMCHECKBOX Adults & Youth FORMCHECKBOX Other (specify): FORMTEXT ?????2. Will you be serving food? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, who is providing? FORMCHECKBOX Group member FORMCHECKBOX Caterer-delivered FORMCHECKBOX Caterer-prepared/served**If you are hiring a catering company to prepare/serve food on site a Catering Application is required. See Facility Rental Guidelines for all requirements. 3. Will you be serving alcohol? FORMCHECKBOX Yes** FORMCHECKBOX No Will you be selling alcohol? FORMCHECKBOX Yes** FORMCHECKBOX No**If yes, a Banquet Permit or Special Occasion License and server with a Class 12 Permit are required. See Facility Rental Guidelines for all requirements that must be met for approval. Alcohol service must be approved a minimum of 5 business days’ prior to event date. Alcohol service may not be approved during hours of scheduled youth programs in the complex.4. Will there be music? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, please specify: FORMCHECKBOX Stereo FORMCHECKBOX DJ FORMCHECKBOX Live (which instruments?) FORMTEXT ????? Note: Music must be turned off by 11pm. If there will be dancing, renter may be required to rent a dance floor.5. Will you be collecting admissions? FORMCHECKBOX Yes FORMCHECKBOX No Estimated Amount: FORMTEXT ????? 6. Will you be selling concessions? FORMCHECKBOX Yes FORMCHECKBOX No Vendor Name: FORMTEXT ????? 7. Are you hiring an event or equipment company to provide a Big Toy/Inflatable? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, name of rental agency: FORMTEXT ????? Note: Special regulations must be followed and is only allowed in the Gym. 8. Indicate the facility you want to reserve (mark all that apply): FORMCHECKBOX Conference Room FORMCHECKBOX Family (Games) Room*** FORMCHECKBOX Mirror Room*** FORMCHECKBOX Theatre FORMCHECKBOX Community Room FORMCHECKBOX ? Community Room FORMCHECKBOX Gym – Sports Use*** FORMCHECKBOX Gym – Social Use*** FORMCHECKBOX Kitchen (off Family Room) FORMCHECKBOX Kitchen (in Community Room) FORMCHECKBOX Art RoomNote: *** No food or drink allowed. Pool tables in Family Room cannot be moved. EQUIPMENT9. Describe any equipment you intend to bring with you to use: FORMTEXT ?????10. On-site equipment to be used (mark all that apply): FORMCHECKBOX PA System w/microphone FORMCHECKBOX Podium FORMCHECKBOX Grand Piano (Theater only) FORMCHECKBOX Screen11. Kitchen equipment needed (mark all that apply): FORMCHECKBOX Warming Oven (must rent Family Room Kitchen) FORMCHECKBOX Dishwasher (must rent Family Room Kitchen) FORMCHECKBOX Coffee Urn (bring coffee/liners) FORMCHECKBOX Refrigerator FORMCHECKBOX Freezer FORMCHECKBOX Small MicrowaveCONTACT INFORMATION Crossroads Community CenterAfter Hours Emergencies:16000 NE 10th Street, Bellevue, WA 98006Bellevue Parks Resource ManagementPhone: 425-452-4874Phone: 425-452-6855Fax: 425-452-7854Email: CrossroadsRental@ ................
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