Application for use Name of Event(Required) Sponsoring Party Name of 501(c)(3) Organization (If Applicable) EVENT INFORMATIONDate(s) Requested MM slash DD slash YYYY Event Start Time(Required) Hours : Minutes AM PM AM/PM Event End Time(Required) Hours : Minutes AM PM AM/PM Load-In Start Time(Required) Hours : Minutes AM PM AM/PM Estimated Attendance(Required)Event Description(Required)Check All That Apply Free to the Public By Invitation Only Tickets for Purchase CLIENT INFORMATIONEvent Applicant(Required) Phone(Required)Name of Designated Event Contact(Required) Designated Contact Phone(Required)Information Emailed To(Required) Signature of Applicant(Required) Application Date(Required) MM slash DD slash YYYY Will you require food and/or non-alcoholic beverage catering for your event?(Required) Yes No Will you require alcoholic beverage service at your event?(Required) Yes No Will you require entertainment at your event?(Required) Yes No Will you require signage/decoration(s) at your event?(Required) Yes No ***NOTE: No outside food or beverages are permitted at Fox Pointe without the express written consent of the Venue Director or designee. The Event Applicant is responsible for providing catering for all events. Catering may include, but not necessarily be limited to, the provision of linens, dinnerware, glassware, flatware, tables, chairs, chair coverings, cake stands, and centerpiece items. Any costs for the services and goods provided for in this Section are the sole responsibility of the Event Applicant. Food and beverage preparation and sales must comply with the Code of Ordinances of the Village of Lansing, Cook County, Illinois, and all other applicable laws, codes and regulations. The Village will be responsible for supplying alcoholic beverages and bartenders at Fox Pointe events approved for liquor service. Any costs for these services and goods are the sole responsibility of the Event Applicant.Summary of Event(Required)Notes/Special Requests(Required)DAILY RENTAL FEES Fox Pointe is available for rent from May 1st through October 31st. Rental fees for the use of Fox Pointe shall be assessed as follows: Resident Rates Sunday - Thursday $1,000 per day Friday and Saturday $1,250 per day Non-Resident Rates Sunday - Thursday $1,500 per day Friday and Saturday $1,750 per day DAMAGE DEPOSIT A separate and refundable Damage Deposit of $1000.00 is required upon approval of this Application for Use. The Damage Deposit is separate from the rental fees referenced above and other fees as set forth in the Fox Pointe Usage Policy.PAYMENT ARRANGEMENTS Security Deposit Date MM slash DD slash YYYY Security Deposit AmountCheck Number Rental Fee Date MM slash DD slash YYYY Rental Fee AmountRental Fee Check Number INSURANCE The Village may, at its sole discretion, require an Event Applicant to obtain liability insurance. If applicable, Event Applicants are required to obtain liability insurance written in the name of the Village of Lansing as insured. The event being covered by the insurance must be named on the insurance certificate. CONTACT INFORMATION OF INSURANCE AGENT (IF REQUIRED)Name First Last Email PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country ACCEPTANCE OF TERMS This Application for Use is subject to compliance with the Fox Pointe Usage Policy; all written conditions attached and executed by the Village Administrator or his designee(s); and all applicable Village Ordinances, conditions, and requirements. Event Applicants are required to have read, and by executing this Application for Use, attest to have read and agree to the conditions and regulations set forth in the Fox Pointe Usage Policy. NOTE: At any time, the Village reserves the right to refuse a request to book Fox Pointe if it’s deemed advisable and in the best interest of the health, safety, and welfare of the residents of Lansing. Additionally, modifications to any section of this application or the Fox Pointe usage policy may be considered if deemed advisable and in the best interest of the health, safety, and welfare of the residents of Lansing. Signature of Applicant or Representative(Required) Date(Required) MM slash DD slash YYYY Usage Policy(Required) I have read and accept the Usage Policy of the Village of Lansing's Fox Pointe 97640
