APPLICATION FOR THE USE OF POTOMAC STORM GYM64 Dupont Rd., Martinsburg, West Virginia 25404
EMAIL POTOMAC STORM GYM MANAGER
PLEASE ANSWER ALL APPLICABLE QUESTIONS
1. PRINT Name, address, phone number, and email address of Individual & Organization (if applicable) requesting use of Potomac Storm Gym and/or equipment, hereinafter referred to as the 'Requester'
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Print Name of Renter & Organization (if applicable)
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Print Address, Phone #, and Email
2. Requesting Use Of ( Check All That Apply )
ONE Volleyball Court_____ TWO Volleyball Courts_____ ONE Basketball Court_____
Volleyball Serving/Passing/Setting Machine - $10 _____ 10 Volleyballs & 1 Volleyball Cart $10 _____
Acu-Spike Volleyball Spike Trainer - $10 _____ Precision Volleyball Setting/Passing Target - $10 _____
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(List Other Equipment Requested)
3. Dates & Times of Usage:
Requested Usage Date (Month/Date/Year): ___________________, 20_______
Requested Usage Start & End Times (2 Hour Minimum): ___________________
4. Purpose for Use of Potomac Storm Gym:
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(i.e., Sports Lessons, Sports Practice, Sports Tournament, Team/Club Tryouts, or Other — Please be specific)
(a) Will admission be charged: Yes _____ No _____ If YES, How Much? _________________(b) Will anything be sold: Yes _____ No _____ If YES, What? __________________________
(c) Total number of persons who will be entering the facility (Limited to 25 per court): _________
(d) BELOW - Print the FULL name of each person who will be entering the Potomac Storm Gym, & indicate if
they are current Potomac Storm VBC coach, player, and/or parent by adding - PSVBC after the last name.
Also, indicate which person will be acting in a coaching capacity by putting COACH before the person's name and the club where they coach after their last name.
Example: (1) Jane Doe - PSVBC, (2) COACH John Doe HUB CITY, (3) Julie White, (4) Emma Brown, etc.
Attach a copy of team rosters (for scrimmages and tournaments).
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(e) Renter agrees that every person named in Section 4(d) MUST submit a signed & completed original (unredacted) copy of the Release of Liability for Use of Facility and/or Equipment before Potomac Storm VBC LLC will approve Renter's request to use the Potomac Storm Gym and/or equipment. Renter understands and agrees that if this Request is approved by Potomac Storm VBC LLC, only persons specifically authorized by name, in the approval emailed from [email protected], shall be permitted to enter the Potomac Storm Gym during the time(s) and date(s) outlined in the said approval email, and any persons not specifically named in the approval email, from [email protected], are NOT authorized to enter the Potomac Storm Gym. It is understood and agreed that if unauthorized persons are found in the Potomac Storm Gym, during the time(s) and date(s) it is used by the RENTER, the terms and conditions of this agreement and the resulting approval for use of the Potomac Storm Gym shall be understood to have been violated by the RENTER, who shall be understood to have forfeited any right to use the Potomac Storm Gym and/or equipment, that RENTER and all parties accompanying RENTER shall immediately vacate the Potomac Storm Gym and forfeit any right to any refund for any amounts paid.
5. Approval To Use Potomac Storm Gym and/or Equipment
Any approval to use the Potomac Storm Gym would be emailed, to the Renter's supplied E-mail, from [email protected]
6. Responsibility For Missing and/or Damaged Equipment & Property Damage
The Renter understands and agrees that they accept all financial liability for the full replacement cost of any missing or damaged equipment and/or other property damage that occurs as a result of the use of the Potomac Storm Gym and/or equipment by the Renter or any member of the Renter's group, and that any said damages are to be paid immediately to Potomac Storm VBC LLC, upon demand.
7. Requirement To Clean Gym Area Used
Renter understands and agrees that Renter is responsible to clean the Potomac Storm Gym area used, prior to leaving, and that should the Renter fail to do so, Potomac Storm VBC LLC will clean the area and equipment used, the "Person Requesting Use" below agrees to pay, to the CLUB, a $40 Clean Up Charge for each court rented (1 court = $40 and 2 courts = $80).
8. ORGANIZATIONS INSURANCE REQUIREMENT
Prior to approval, organizations requesting use of Potomac Storm Gym and/or equipment must submit, a current Certificate of Insurance provided by a WV licensed insurer, for the dates requested and in the amount of $5,000,000.00, for the purpose of insuring Potomac Storm VBC LLC and/or FW Properties LLC against any claim which may arise due to any accident, injury, death, or financial loss, which might occur to any person(s) participating in any event held at the Potomac Storm Gym while the said GYM is being used by the Organization named below.
(A) Has your organization obtained and attached a valid and current certificate of liability insurance, listing Potomac Storm VBC LLC and FW Properties LLC as additional insured parties?
Place an X (indicating Yes or No). Yes _____ No _____
Sign and complete the information below, verifying your answer, and attach a copy with this Request
Print Organization's name and address: ________________________________________________________________
Print name & title of authorized representative: ___________________________________________________________
X________________________________________________________________________________Date: ____________
Signature of the organization's authorized representative
9. AUTHORIZATION TO USE: If the request is approved, a Time/Date Specific AUTHORIZATION TO USE PSVBC GYM will be emailed from [email protected].
10. PAYMENT DUE: No less than 48 hours prior to the approved use date, the full non-refundable payment for gym and equipment fees (as indicated in the Authorization to Use Email from Potomac Storm VBC) MUST be made to Potomac Storm VBC LLC
11. CLEANING FEE: Clean the GYM prior to leaving. If PSVBC staff has to clean up for your group, the "Person Requesting Use" below agrees to pay, to the CLUB, a $20 Clean Up Charge for each court rented (1 court = $40 and 2 courts = $40).
12. FEE SCHEDULE:
(A) GYM FEES FOR "NON-STORM PLAYERS / GROUPS"
(IF ALL PARTICIPANTS ARE NOT 2023-24 STORM TRAVEL OR FALL LEAGUE PLAYERS)
ONE COURT - $30.00* PER HOUR - 1 HOUR MINIMUM
TWO COURTS - $55.00* PER HOUR - 1 HOUR MINIMUM
*** USE OF ANY PSVBC TRAINING EQUIPMENT / MACHINES IS AN ADDITIONAL FEE ***
(B) GYM FEES FOR "CURRENT STORM MEMBERS"
(ALL PARTICIPANTS MUST BE 2023-24 STORM TRAVEL OR FALL LEAGUE PLAYERS)
ONE COURT - $20.00* / HOUR - 1 HOUR MINIMUM
TWO COURTS - $35.00* / HOUR - 1 HOUR MINIMUM
*** USE OF ANY PSVBC TRAINING EQUIPMENT / MACHINES IS AN ADDITIONAL FEE ***
(C) OPEN GYMS
(1) "Open Gyms" are ONLY scheduled by and supervised by Potomac Storm VBC administrators
(D) PAYMENT & APPLICATION VIOLATIONS
(1) ***Coaches fees are NOT included in gym and/or equipment rental fees***
(2) NO gym and/or equipment rental payments should EVER be made to any coach(es).
No coach(es) shall collect or retain any payment for use of the Potomac Storm Gym and/or equipment. Any violation of this policy will result in the coach(es) and player(s) being prohibited from any future use of the gym and/or gym equipment.
(3) No request for use of the Potomac Storm Gym shall be made through any coach. Any parent/player/group, and/or organization wishing to use the Potomac Storm Gym and/or equipment must directly contact Potomac Storm VBC and complete, as required, this Application/Agreement.
13. ORGANIZATIONS MUST COMPLETE & SUBMIT THE "AGREEMENT OF INDEMNITY" BELOW
AGREEMENT OF INDEMNITY FOR USERS OF POTOMAC STORM GYM (64 DUPONT RD. MARTINSBURG, WV)
The undersigned, in consideration of being granted permission to use the Potomac Storm Gym facilities and property, located at 64 Dupont Rd., Martinsburg, WV, agrees that the undersigned, and the organization that they represent - including its officers, owners, agents, assigns, and members, shall indemnify and hold forever harmless FW Properties LLC and Potomac Storm VBC LLC, their officers, agents, assigns, employees, volunteers, and members, against any liability which results in any accident, injury, death, or financial loss that may occur to the "Person Requesting Use" and anyone in the user's group, during, or as a result of, any such person(s) use of the Potomac Storm Gym facilities and property. The undersigned further agrees to defend against any claim brought against FW Properties LLC and/or Potomac Storm VBC LLC, their officers, agents, assigns, employees, volunteers, and members, as a result of any such accident, injury, or death. The undersigned "Person Requesting Use" further covenants and agrees that it shall be covered by an appropriate liability insurance policy in the amount of no less than $5,000,000.00, as described in #8 above, for the purpose of insuring against any accident, injury, death, or financial loss, which shall occur as a result of any accident, incident, or loss, during or as a result of the said person(s) and/or group(s) use of said facilities and property, as required herein.
I, the undersigned, also attest that I am lawfully authorized to represent the myself, the individuals who shall use the Potomac Storm Gym, and any sports organization that I am requesting use of the Potomac Storm Gym on behalf of, that WE have read this APPLICATION FOR THE USE OF POTOMAC STORM GYM, including the AGREEMENT OF INDEMNITY FOR USERS OF POTOMAC STORM GYM, fully understand the terms, understand that individuals and/or organizations making use of the gym give up substantial rights by signing it, that I/we have had opportunity to have it reviewed by an attorney, and sign it freely and voluntarily without any inducement.
PRINT NAME OF PERSON REQUESTING USE: __________________________________________________________________
ADDRESS OF PERSON REQUESTING USE: _____________________________________________________________________
SIGNATURE OF PERSON REQUESTING USE: ____________________________________________
DATE: ___________________________________
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BEFORE ANY USE OF THE POTOMAC STORM GYM, ALL PERSONS ENTERING THE GYM MUST READ, SIGN, AND DATE THE 'RELEASE OF LIABILITY' BELOW & SUBMIT IT TO POTOMAC STORM VBC
RELEASE OF LIABILITY and ASSUMPTION OF RISK AGREEMENT
FOR USE OF FACILITY AND/OR EQUIPMENT
READ BEFORE SIGNING
IN CONSIDERATION OF the undersigned, their spouse, and any minor children, being allowed to participate in ANY event and/or activity held by or on any premises owned or leased by FW Properties LLC and/or Potomac Storm VBC LLC (Potomac Storm Volleyball Club), their owners, officers, agents, assigns, members directors, employees, volunteers, sponsors, advertisers (hereinafter individually and collectively known as the CLUB), whether such activity is at the Potomac Storm Gym, located at 64 Dupont Road, Martinsburg WV, or at any other facility or address utilized by the CLUB, the undersigned understands and agrees that the risks of injury, illness (including communicable diseases such as MRSA, influenza, and COVID-19), permanent disability and accidental death, to my child/myself/and others from the activities involved in these programs are significant and further agree that I, for myself, my spouse, and child/children:
KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE CLUB, or others, and assume full responsibility for the use of the Club's facility(s) and equipment (whether leased or owned), by my child/children; and,
Willingly agree to comply with the Club’s stated and customary terms and conditions for participation, including the CLUB policy of no refunds of fees paid. If I observe any concern, I will remove my child from the participation and the CLUB's facility immediately; and,
And on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY, RELEASE, AND HOLD HARMLESS the CLUB, WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, LOSS (including but not limited to any financial loss of any membership fee, facility fee, and/or participation fee paid to the CLUB), OR DAMAGE to person or property, incidental to my child’s involvement or participation in these programs and/or use of the CLUB's facility(s) and/or equipment, WHETHER ARISING FROM THE NEGLIGENCE OF THE CLUB OR OTHERWISE, to the fullest extent permitted by law.
Affirm that I have explained to my child/children/ward: the risks of the activity, their responsibilities for adhering to the directions, rules, and regulations, and that my child/children/ward understands this agreement.
Affirm that I have explained to my spouse and child/children the risks of the activity, their responsibilities for adhering to the rules and regulations, and that my spouse and child/children understand this agreement.
I, FOR MYSELF, MY SPOUSE, AND CHILD/WARD, HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND IT'S TERMS, UNDERSTAND THAT WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
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Print Name(s) of Parent(s)
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Signature(s) of Parent(s)
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Print Name(s) of Children
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Signature(s) of Children
Date: __________________, 2024
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