As the undersigned, I agree to the following rules when using the PCC POA Activity Center

SMOKING IS NOT ALLOWED IN THE POA BUILDING

THE ROOM IS FREE FOR POA MEMBERS, EXCEPT FOR $25.00 REFUNDABLE CLEANING CHARGE. THE POA MEMBER MUST BE THE RESPONSIBLE PERSON AND THE ONE WHO SIGNS THIS AGREEMENT.

  (YOU MUST BE  A POA MEMBER IN GOOD STANDING)

            IF YOU ARE NOT A POA MEMBER:  I will pay the appropriate NON-REFUNDABLE

            charges as listed in advance:

q       I will pay $10.00 each usage for up to 24 people.

q       I will pay $50.00 each usage for 25 or more people.

I understand that the office area and all equipment is off limits (i.e. copy machine, telephone, typewriter, etc.), but I may use all other facilities to include the kitchen.

If I have the activity center scheduled for a continuous regular meeting date and time, I understand that if another POA member has a special occasion (i.e. Birthday, Anniversary, Etc.) that is held on a specific date, I could be requested to change that particular meeting date.

If I have a meeting after hours, I will sign the key out the afternoon of the same day and return it no later than 0830 the following day to the POA Office. 

I will clean the kitchen and remove all garbage (if used).

All tables, chairs, etc, brought in by meeting members will be removed prior to departure.  If not, I understand they will be discarded.

I will be held responsible to ensure all doors and windows are secure prior to my departure.

I understand I am personally responsible for paying any additional charges incurred by the POA created by my usage (i.e. repair damages, hire a cleaner, etc.).

I UNDERSTAND AND AGREE TO ALL OF THE ABOVE.  I AM REQUESTING THE USE FOR

DATE__________ TIME FROM__________TO__________.

PRINTED NAME_______________________________________

SIGNATURE AND DATE________________________________

DATE AND TIME SIGNED INTO ROOM (OR SIGNED FOR KEY)__________

DATE AND TIME SIGNED OUT OF ROOM (OR RETURNED KEY)__________

POA OFFICE WITNESS TO THE ABOVE______________________________