BUILDING USE APPLICATION

QEMS BUILDING USE REQUEST FORM

* Indicates required field

Name *

First

Last

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Date Requested *

9Time Requested *

Purpose for the Reservation *

PLEASE REVIEW THE ROOM USE POLICY:

HIGHLY RECOMMEND A TOUR OF THE EVENT ROOM PRIOR TO RESERVATION TO ENSURE IT WILL ACCOMODATE YOUR EVENT.
THE ABOVE PERSON/ORGANIZATION IS RESPONSIBLE FOR ANY DAMAGES TO THE BUILDING DURING THEIR USE. THEY ARE ALSO RESPONSIBLE FOR CLEAN UP AFTER THE ORGANIZATION FUNCTION IS COMPLETED.

MAX CAPACITY OF THE EVENT ROOM WILL BE NO MORE THAN 30 INDIVIDUALS AND ARE REQUIRED TO WEAR A MASK AT ALL TIMES IF THEY HAVE ANY COLD/FLU SYMPTOMS.
MAXIMUM TIME FOR USE IS 3 HOURS; CAN ARRIVE 60 MINUTES PRIOR TO START OF EVENT TO DECORATE/SET UP.

A $200 DONATION IS REQUIRED TO UTILIZE THE ROOM.
PARKING SHALL BE LIMITED TO THE FRONT RIGHT SIDE OF THE BUILDING; WE DO HAVE AVAILABILITY FOR OVERFLOW UPON REQUEST.

SMOKING IS NOT ALLOWED ON THE PREMISIS.

NO VISITORS WILL BE ALLOWED TO “WALK AROUND” THE FACILITY AND ENTER THE AMBULANCE BAYS.

By signing this form, you agree to take full responsibility of the building to assure it will be cleaned after the event and assume all responsibility for any damages that may occur during your event. Visitors will ONLY be allowed to be in the meeting room, kitchen, the main parking areas and utilize the main bathrooms only.

DUE TO ADHEREING TO THE AGENCY COVID POLICY, SPECIAL REQUESTS AND APPROVAL FOR AN AMBULANCE TOUR MUST BE MADE THROUGH THE CAPTAIN ONLY.

Name of Requester *

Date *

Submit

YOUR CART

QEMS BUILDING USE REQUEST FORM