Facktory Rental, Release and Waiver Form

Responsible Party: Name ________________________________________________________________________
Street________________________________  City_______________________________ State ______  Zip______
Phone Number (home) ____________________ (work) _____________________ (mobile) ____________________

Purpose of Rental ________________________________________________Date of Rental___________________
Rental Fee: __________________  Date Paid ____________________      Cash or Check (circle one)
Time of Rental:  From  _______________ To _______________  Number of Participants (estimated)  ___________

The responsible party/renter agrees to hold harmless the Facktory, it's employees, and it’s officers from and against any and all claims, suits, actions, damages and /or causes of action arising during the term of this agreement, for any personal injury, loss of life, property and/or damage to property sustained in or about the said premises, and from and against all costs, expenses and liability incurred in and about any such claims the investigation thereof or the defense of any action process brought thereon and from and against any orders and/or judgments that may be entered therein.

The responsible party/renter further agrees to adhere to the rules and regulations of the Facktory and to be responsible for any damages to the property and/or facility that are a result of any action (s) of the participants at the function for which the facility is rented. Any other rules which may apply will be listed in an addendum.

The Facktory is handicap accessible.

Party/Renter______________________________________________________  Today’s Date________________

Factory Representative _____________________________________________  Today’s Date________________

Please tell us how you learned about The Facktory:______________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________