General Waiver FormPlease enable JavaScript in your browser to complete this form.Name *FirstLastDate *Email *Phone *AddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryDate of RentalTerms & Conditions *I agree to the terms and conditions.The building will be rented to Qualified Persons only, as defined by the Fairfield Civitan Club Building Lease Conditions, Rules and Standards document attached and as determined by the Civitan rental manager, any and all of which will hereafter be termed the Lessee. * Rental fee is $650. Half of the base rental fee $300 (rent deposit) is payable in advance with the completed Lease Agreement Form. This will also reserve the building for Lessee, for the date of the rental. A security deposit of $400 (cash or money order) and the balance of the rental fee $300 must be paid prior to the time the key is issued. All checks should be made out to "Fairfield Civitan Club". The security deposit will be returned, to the Lessee, by mail within 7 days after the rental once it is verified that the property was fully cleaned and left in the condition specified in the Fairfield Civitan Club Building Lease Conditions, Rules and Standards document attached. Arrangements can also be made by the Lessee for an on-site inspection with the building rental manager to get the deposit back sooner. * The term of this rental is the 24-hour period specified by the Date of Rental above. Cleanup should be done immediately at the conclusion of the rental and Lessees should secure and clear the property by 1 AM of the day following the rental. Optional clean up instructions MAY be made, and agreed upon, by the rental manager. * Notification of cancellation must be made at least TWO WEEKS prior to the rental date; otherwise the rent deposit will be forfeited. * The attached Fairfield Civitan Club Building Lease Conditions, Rules and Standards document is a part of this lease contract and all Lessees shall become familiar with the requirements of that document and abide by them. Use of the Civitan Building shall be wholly at the risk of that person (Lessee) and the Lessee shall protect and hold harmless the Fairfield Civitan Club and its members from claims arising out of the use of the Civitan Building by the Lessee, his/her family, guests or anyone allowed on the premises by Lessee. Use of illegal drugs or any controlled substance are not permitted in the Building or on the grounds of the Fairfield Civitan Club. Lessee is subject to security deposit loss if any illegal drugs are found on the grounds. Lessee MUST BE AT LEAST 21 YEARS OF AGE AND BE PRESENT AT ALL TIMES DURING THE EVENT. These person/persons must sign below as the Lessee and must have the authority to bind the renting group. * I understand that this is a binding contract, and I agree to all the terms above. Your Signature *Clear SignatureSign Waiver