Revised 09/04/2008
Central State University
Department of Health, Physical Education, & Recreation
Wilberforce, OH
Application for Use of Walker Gymnasium (322)
DATE OF APPLICATION
DATE OF EVENT
NAME OF ORGANIZATION
SIGNATURE OF PERSON MAKING APPLICATION LOCAL ADDRESS/ PHONE #
NAME OF EVENT AS IT IS TO BE LISTED ON CALENDAR
TYPE OF EVENT (MEETING, ATHLETIC EVENT, ETC.)
TIME BEGINNING
TIME ENDING
Additional equipment and set-up requirements:
Required Signatures:
Signature required from Office of Facilities Management
Chairs: ____________________
Advisor
Floor Tarps: ____________
HPER Department
Security
Rental Fee $200.00 (Per Event)
For Outside Organizations &/or Groups
Custodial
Student Leadership and Development
Chair, HPER
(Final Approval)
Dean, COE
(Final Approval)
Revised 09/04/2008
WAIVER OF LIABILITY
Groups or organization must make their own arrangement for security and custodial services.
These arrangements should be made when signatures are obtained from these offices.
Central State University reserves the right to require Security Officers and/or custodial workers
to be employed by the organizations if in the opinion of CSU the nature of the event requires
such services.
The ______________________________________________ (Name of Organization using
Walker Gymnasium) agrees that said organization, its member, guests and paid attendees holds
Central State University, its agents and employees harmless for an