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REQUEST FORM	CHEY= ENNE COUNTY FAIRGROUNDS, COMMUNITY BUILDING & EQUIPMENT
<= /td>	(Must be 18 years of age or = older to sign contract-driver's license required)
=
O= rganization/Business/Family/Etc
R= equesting Use		(please print)
=
R= equest use of:	COMMUNITY BLDG.	and/or	GROUNDS	and/or		EQUIPMENT
<= /td>	_____	Auditorium	_____	Arena		_____	Amp. Box
<= /td>	_____	Meeting Room	_____	Track		_____	Microphone
Keys		_____	Kitchen		_____	Grandstands seating	_____	Stage (6")
		_____	Piano		_____	Under Grandstands	_____	Stage ( 12")
		_____	Podium		_____	North Concession	_____	Peg display boards
		_____	VCR/TV		_____	South Concession	_____	Announcers Trailer
		_____	PA system	_____	Cover area/tables	_____	Large Picnic Tables
		_____	East Covered	_____	North Restrooms	_____	Poles/Barrels
		area/tables	_____	Old 4-H Building	_____	East Concession
		_____	Tables 6'		_____	Ag Building	_____	East Bathrooms
		_____	Tables 8'		_____	Merry Go Ground
		_____	Tables circle sec.	_____	South Horse Stalls	____Other
<= /td>	_____	Chairs		_____	North barns/stalls	____Other
<= /td>	_____	Rodeo Office (east)	____Other
=
W= ill facilities be used for activities with any type of cost? Admission, Donations, Items for Sale?	Yes___ NO___
=
D= escribe usage - event etc.
=
Set up			Event			Cleanup
date/time			date/time			date/time
=
= I have read all the policies on use of County facilities, equipment etc. and will inform the above named group &/or
= persons of their contents. I understand that any violation of any condition of the policies, or this agreement may
= result in no further use by this group/persons. I understand NO ALCOHOL and NO SMOK= ING are allowed in the
C= ommunity Building.	I understand that all or a p= art of the fees & deposit are forfeited if any violation occurs.
=
= I hereby declare that I and/or the group/persons represented by me in this activity will not hold Cheyenne County,
= the Cheyenne County Fair Board or any individual or group of individuals associated with these entities responsible
= for any accident, injury, illness or loss of property associated with the activity for which request for the use of county
f= acilities, equipment etc. is being made.
=
(= Group must notify the Sheriff's Department prior to any dance event at the fairgroun= ds)
S= ecurity has been arranged for dances and other activities that security is needed= .	Provided by:
=
S= ignature of Sheriff's Department: ______________________________________________
=
P= rinted Name of Sheriff's Department: __________________________________________
=
(= groups agree to pay any damages in excess of deposit)
DEPOSIT	$500.00		FEE	$
D= ance & Wedding Party Deposit (Exluding youth groups) $1000.00
<= /td>		In the event th= at any violation(s) occurs
						and your deposi= t is forfeited, you may
Signature			appeal to the C= heyenne County Board
<= /td>					of Commissioner= s by calling (719) 767-
M= ailing Address			5872 to request= a hearing or send your
<= /td>					appeal in writi= ng to P.O. Box 567,
<= /td>		Cheyenne Wells,= Co 80810.
Phone			Date
<= /td>	Violations will be determined by
I= have received a copy of the policies &		please initial		walk-thru after event by:
a= greement
<= /td>	Violations:
A= pproval for use
<= /td>
A= pproval for deposit refund
<= /td>
N= ot approved for deposit refund/why

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