Coon Rapids Civic Center Rental Application

2. Name of Event for Display Monitor (i.e. names of bride and groom, birthday person, etc.)

4. Name of Organization and/or Troop Number (if applicable)

6. First Name*

7. Last Name*

9. Address1*

11. City*

12. State*

13. Zip*

15. Primary Phone Number*

17. Email Address

19. Verify Email Address Again

21. Alternate Contact Name

22. Alternate Phone Number

24. Alternate Email Address

26. Day & Date Requested *

    If multiple dates, please list them all here. No need to fill out multiple applications.

27. Time Requested*

28. Estimated guest count:*

30. Room(s) Requested:*

    1. Banquet Facility (includes Civic Rooms A, B, & C)
    2. Civic Room A (seats up to 80)
    3. Civic Room B (seats up to 80)
    4. Civic A & B (seats up to 160)
    5. Civic Room C (seats up to 60)
    6. Gazebo
    7. Conference Room 5 (seats up to 14)
    8. Arts & Crafts Room (seats up to 24)
    9. Recreation Room (seats up to 20)
    10. Kitchen

32. Purpose of Use:*

34. Are you serving alcohol?*

    1. Yes
    2. No

36. Do you need a special set up or other special arrangements?

38. Have you rented with us before?*

    1. Yes
    2. No

40. How did you hear about us?*

    1. I live in Coon Rapids
    2. I've attended another event here
    3. Web search
    4. MN Budget Bride
    5. Twin Cities Wedding Association

    1. Meetingpages.com
    2. Facebook
    3. Twin Cities Gateway
    4. Other

42. Applicant agrees to protect, indemnify, defend, save and hold harmless the city of Coon Rapids and its officers and employees from any and all claims, liabilities, damages or right of action directly or indirectly arising out of the use of facilities. I affirm that the above statements are true and I further affirm that I have read and understand all policies and information and that I am 18 years of age or older.

    Applicant agrees to protect, indemnify, defend, save and hold harmless the city of Coon Rapids and its officers and employees from any and all claims, liabilities, damages or right of action directly or indirectly arising out of the use of facilities. I affirm that the above statements are true and I further affirm that I have read and understand all policies and information and that I am 18 years of age or older.

44. Signature of Applicant*

45. Date*

47. This application is not a valid contract until appropriate fees have been received by the City of Coon Rapids and the contract is signed by the Facility Coordinator. Applicant will be notified when application is approved or denied.

    This application is not a valid contract until appropriate fees have been received by the City of Coon Rapids and the contract is signed by the Facility Coordinator. Applicant will be notified when application is approved or denied.

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

    This field is not part of the form submission.

50. Submit Submit and Print

* indicates a required field