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2. 
4. Jenks Fire & Rescue
   1115 W 121st St
   Jenks, OK 74037
   918-298-1491
6. Applicant Name*
7. Date of Application*
   Date of Application
9. Organization*
10. Type of Organization*
12. Organization Non-Profit (501C3C?)*
14. Contact Person*
15. Phone Number*
17. Email Address*
19. Address*
21. City*
22. State*
23. Zip Code*
25. Alternate Contact Person
26. Phone Number
28. City
29. State
30. Zip Code
32. Reservation date and time*
    Reservation date and time

    Reservation date and time
34. HOLD HARMLESS AGREEMENT
    I, the undersigned, in consideration of the City of Jenks allowing me to use the Conference Room at the Ewing-Perryman Fire Station do hereby for myself, my heirs and assigns, or as authorized on behalf of my organization as specified below, AGREE to release and hold the City of Jenks, its officers or employees harmless for any and all claims which I may have now or in the future resulting from the use of said Conference Room, the condition of the Conference Room, actions by fellow users of said Conference Room and entry upon City of Jenks property of use of said Conference Room. I understand that I assume all risks in association with the use of the Conference Room at the Ewing-Perryman Fire Station.
36. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
38. Electronic Signature*
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field