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Application for Use of Hardin County Courthouse Grounds

This form has been modified since it was saved. Please review all fields before submitting.

Steps

1. Event This section is complete This section is incomplete
2. Organization Information This section is complete This section is incomplete
3. Event Details This section is complete This section is incomplete
4. For County Use Only This section is complete This section is incomplete

Event

Date of Use*
Date of Use
End Date
End Date
(if more than 1 day)
Time Requested*
Time Requested Start Time
—
Time Requested End Time
Enter the start and end times of the event.
Name of Event:*
Type of Event:*
Continue

Organization Information

Group Requesting Use:*
Name of Person Responsible:*
Address:*
Include street, city, state, and zip code.
Phone #:*
Fax:
Email:
Has this organization used the Courthouse grounds for other events?
1. Yes
2. No
If yes, please list functions and dates:
Continue |Go Back

Event Details

Courthouse Grounds Area*
Describe the specific areas of the Courthouse grounds you request to use.
Is the event open to the general public?*
1. Yes
2. No
Number of participants expected:*
What equipment will be used on the Courthouse grounds?*
Ex: chairs, tables, electrical equipment, etc.
When will the equipment be set up?
If held outside, will food be served for a fee?
1. Yes
2. No
1. NA
If yes, has the appropriate Health Department permit been obtained?
1. Yes
2. No
A liability insurance policy naming Hardin County as an "additional insured" is required in the amount of:
Does this group have liability insurance to cover this event?
1. Yes
2. No
I have read the Policy for Use of Courthouse Grounds. I understand that Courthouse grounds will be left in a clean and neat condition after use. I am liable for all damages, expenses, and loss caused by any person who attends or participates in this scheduled event. By signing this application, I agree to defend and hold harmless the County regarding any damage which may occur as a result of this scheduled function.
Electronic Signature of Applicant*
1. By selecting this option the applicant indicates agreement with and understanding of the application process, policies, and requirements.
Date*
Date
Continue |Go Back

For County Use Only

Date Received:
Date Received:
Date Certificate of Insurance Received:
Date Certificate of Insurance Received:
Approved by Board of Supervisors
Complete this section if this application is recommended for approval.
Date
Date

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
Submit Submit and Print | Go Back

* indicates a required field

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Hardin County Courthouse | 1215 Edgington Avenue | Eldora, IA 50627
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