Service Activity Application

Phone: 805-736-3423 ' Fax: 805-735-7672
815 West Ocean Avenue, Lompoc, CA 93436

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Fields marked with * are required to submit the form.

The undersigned, herein known as the "Applicant", understands and agrees that Applicant shall assume all risk for loss, damage, liability, injury, cost, or expense that may occur during, or as a result of the proposed Service Activity.

Indemnity: The Applicant further agrees that in consideration of permission to use the property, or properties above, Applicant will save, defend, and hold the Housing Authority of the County of Santa Barbara, its affiliates, and/or its employees, including any Property Owners of the Designated premises, free and harmless from any loss, claims, liability or damages, and/or injuries to persons and/or property that in any way may be caused by any acts or omissions of Applicant, its employees, or its agents.

Non-Discrimination: The Applicant understands and agrees that in the performance of this Agreement, the Applicant shall not discriminate in the provision of service activities because of race, color, sex, age, religion, national origin, ancestry, handicap, disability, or familial status.

Prohibited Uses: The Applicant understands and agrees that the Premises shall not be used for illegal purposes, nor for any activity of a commercial nature, nor for the private use of residents or others. In addition, there shall be no requirement or request for any resident or organization to participate or affiliate with any political, religious or ideological cause.

Applicant further understands and agrees that the Premises shall not be used for the purpose of raising funds for any purpose nor used for any activity where a fee is charged except as may be approved by The Housing Authority of the County of Santa Barbara, in writing, pursuant to the rules, regulations and policies established by HACSB, its affiliates, or Property Owners.

Applicant understands and agrees to provide copies of all printed materials to the Housing Authority of the County of Santa Barbara in advance of distribution on Premises.

The undersigned hereby warrants that s/he has the legal authority and capacity to sign this Agreement on behalf of the person and/or organization listed below.

The undersigned certifies to the truthfulness of the information provided herein, and agrees to comply with the requirements of the Housing Authority of the County of Santa Barbara, and any/all Federal, State, County, City, and Municipal Codes, Rules, and Regulations that may pertain to this Service Activity.

By completing and signing this form you are agreeing to these items.

By typing your name you are signing this form and agreeing to all items listed above.