Name of Organization:
Arrival:
day of week: date: arrival time*:
Departure:
day of week: date: departure time*:
*It is important that times be accurate, as premises will be opened and secured accordingly.
Purpose of event or gathering:
Number in group:
If this is an overnight event please indicate number of Male: number of Female:
Please provide the name of the contact person(s) in charge of this event at the center.
For overnight functions, coed groups require BOTH a male and a female "responsible person":
Facilities requested: (please check all that apply)
Outside picnic area ONLY
Lodge - Day Use
Lodge - Overnight Use
Use of athletic equipment (volleyball, quoits, softball, football, etc.)
Bunks are furnished with mattress, pillow, and blanket (total of 28 bunked beds per side).
Individuals should bring their own linens or sleeping bag unless rental of linens is arranged in advance with this office.
INSURANCE IS REQUIRED FOR NON-BUCKNELL GROUPS
Your insurance carrier, in most cases, will be able to provide the certificate needed. If not, you may purchase insurance through Bucknell University.
RATES FOR GENERAL USE FOR NON-BUCKNELL GROUPS
For information on rental fees, insurance fees, and availability, please contact the Events Management Office at 570-577-3095.
WAIVER, RELEASE, AND ASSUMPTION OF RISK
In consideration of the privilege of using Bucknell facilities in accordance with the above request, it is hereby agreed that Bucknell University, its students, officers, faculty, administrators, and/or employees shall not be held liable in the event of accident or injury to any individual who may participate in the above noted event or program, nor for damage to or loss of personal property. The individual or organization requesting the use of University facilities hereby waives any and all claims against Bucknell University, its students, faculty, officers, representatives, or employees resulting from use of Bucknell University property as above noted, and assumes all risk of accident, injury, illness, or damage to or loss of personal property occurring to its guests, members, or participants, and hereby agrees to reimburse Bucknell University and hold Bucknell harmless for any damages, liability, or claims resulting from such use of Bucknell facilities.
- - - entering you name and date is required to confirm you have read and agree to the Waiver, Release and Assumption of Risk - - -
Name: Date:
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