<p> Office Use Upon Submission: Facility Request Form for Date: ______Campus Departments and Private Groups FOR OFFICIALS CONTACT IM COORDINATOR 593-4771 Received By: ______</p><p>Form Complete: ______</p><p>Date Submitted ***FORM MUST BE FILLED OUT COMPLETELY AND SUBMITTED 2 WEEKS IN ADVANCE. ***</p><p>CONTACT INFORMATION</p><p>Person Responsible for Request </p><p>Address City State Zip </p><p>Contact Number Email Address </p><p>Department, Private Group, or Sponsoring Organization:</p><p>I have read and understand the Student Recreation Center Reservation Guidelines.</p><p>Requestor’s Signature ______Department Account # (for fees/costs) </p><p>(For Student Organizations Only): </p><p>Advisor Name______Phone ______E-mail______Does a university department co-sponsor the event No Yes</p><p>Requestor’s Signature______Advisor’s Signature______</p><p>EVENT INFORMATION</p><p>Event Name Approximate Number of People ***IF PARTICIPANTS ARE NOT MEMBERS OF THE SRC, A COMPLETE GUEST LIST MUST BE TURNED IN ADVANCE. ALL GUEST(S) MUST BRING A PICTURE ID AND MUST BE LISTED TO BE ALLOWED INTO THE FACILITY. *** Please provide a description and purpose of the event (BE SPECIFIC).</p><p>Indicate event dates and times below: First Choice Second Choice</p><p>Space Requested Space Requested</p><p>Day(s) & Date(s) Day(s) & Date(s)</p><p>Time of Event Time of Event (beginning/ending) (beginning/ending)</p><p>Set-up Time Set-up Time</p><p>Prior to event, requestor will (check one) </p><p>Submit liability waivers for each participant Purchase insurance from TAMUK Provide proof of liability insurance</p><p>ADDITIONAL INFORMATION</p><p>Will food be served at the event? (If yes, attach menu or food list.) No Yes</p><p>Will fees or donations be collected? $ Per team/ participants No Yes</p><p>Will signage be used for the event? (All signage must be approved by Campus Rec.) No Yes</p><p>Will minors 16 years of age or under attend the event? No Yes Is this reservation for a camp? (If yes, please also see our Student Recreation Camp Rules) No Yes</p><p>Do you need any sports equipment? (If yes, list equipment needed.) No Yes</p><p>FACILITY OPTIONS</p><p>There is no facility fee for Texas A&M University Kingsville Departments requesting facilities exclusively for use by the campus community. For all other requests open to the outside community the facility hourly rates are as follows: Indoor Facilities Cost for Open Event Hours Total</p><p>Lobby – Per Floor $8.00/ hour (Max $80.00)</p><p>Indoor Running Track $20.00/ hour (Max $200.00)</p><p>Gym – Per Quadrant $10.00/ hour (Max $100.00)</p><p>Gym – One Court $20.00/ hour (Max $200.00)</p><p>If requesting gym court area, curtains must be: Up Down (curtain(s)? Outdoor Facilities Cost for Open Event Hours Total</p><p>Outdoor Basketball Court $15.00/ hour (Max $150.00)</p><p>Intramural Field – One Field $15.00/ hour (Max $150.00)</p><p>Intramural Field – Two Fields $30.00/ hour (Max $300.00)</p><p>EQUIPMENT OPTIONS Equipment Cost Quantity Total</p><p>Rectangle Tables (6’) $5.00 each</p><p>Chairs $1.50 each</p><p>Tip n Row Bleachers (Gym area only) $25.00 per section</p><p>Gym Floor Covering $60.00</p><p>Field Paint $25.00 per field</p><p>STAFFING OPTIONS (Required staff may apply) Position Quantity Price per Hour Hours Total CONTACT IM Official (s) COORDINATOR X-4771 Physical Plant Support Prices vary depending on services rendered. When form has been completed please turn in to Student Recreation Center room 203 and schedule an appointment</p><p> with Charles Espinosa, 361-593-3057 to discuss your event layout and needs.</p><p>OFFICE USE ONLY – Form updated 10/17/2013 Do Dates interfere with Campus Recreation and Fitness programs? </p><p>IM Coordinator Initials: ______Fitness and Wellness Coordinator/Lecturer Initials: ______Cheer Coach Initials ______Director Initials: ______</p><p>Office Notes</p><p>Approved as requested Approved with noted change Request declined </p><p>Approval Signature: ______Date: ______</p><p>REQUEST CONFIRMATION: ______Date:______</p><p>Event Director: ______Date: ______</p><p>Amount Due: $______Paid: $______Receipt #: ______</p>