Facility Use Application Form

Purpose and Use: This form is intended to collect the necessary information needed to reserve use of a GSNorCal office space.

Troop or SU Number: *

Facilities Requested (May select more than one space): *

Date of application (use permits are renewable by October 1st each year): * +

Description of activity: *

	Dates of Use	Days of Use	Hours of Use	Estimated Attendance
:	Dates of Use	Days of Use	Hours of Use	Estimated Attendance

Meeting frequency: *

Name: *

Address: *

City: *

State: *

ZIP: *

Day Phone:

Home Phone:

Cell Phone:

Email address: *

Confirm: *

Emergency contact while at the facility:

Name: *

Cell Phone:

Please read carefully and check each box: *

Electronic Signature

I understand that in signing this agreement, I will abide by all rules and regulations of the above facility. I will leave the building clean and free of debris. All tables and chairs are clean and to be arranged as found on arrival.

Girl Scouts of Northern California reserves the right to notify the user 72 hours in advance of cancellation of use of said facility. Council events take priority.

Electronic Signature: By typing my name on this form, I am entering my "electronic signature" (as defined in The California Uniform Electronic Transactions Act 1633.1 - 1633.17) and certifying that I have read, fully understand and accept all terms of this agreement.
Please type your full name here: *

Published February 16, 2021

* Please Note: Once you submit this form, you'll have the option to print the form contents on the following page.