Visitor Request Form

Rock Creek Environmental Studies Center

Application for use of Facilities

Groups of five or more need to register for site use. The following form is provided for your convenience to allow us to plan, reserve for your visit and prevent conflict with other groups.

This form cannot be submitted via the internet. You may either:
1. Type information and print out and then mail or
2. Print out form, and fill in and mail later (address at end of this form)

Group Name

Street Address

Address (cont)

City

State

Contact Person

Date(s) of Requested Use

Time(s) of Requested Use

Number of People

Phone

E-mail

Description of Requested Use

Instructions: Please read an then add addition information below:

1. The RCESC is an educational and research facility open to approved user groups. Access to all or part of the facility may be restricted at times in order to minimize the disturbance to wildlife and vegetation

2. There is no charge for the use of the facility unless, in the judgment of the coordinator, a PCC approved staff person is required for the requested use.

3.Users may not litter, collect or damage vegetation, unnecessarily disturb wildlife, or depart from approved pathways and trails. No bicycle use is allowed and no dogs other than approved guide dogs.

4. Users who require other facilities and services should complete a standard APPLICATION FOR THE USE OF COLLEGE FACILITIES & SERVICES to request them.

your group name
Indemnifies and holds harmless Portland Community College against all claims, losses or liabilities arising from the above use of the RCESC arising from but not limited to the actions of the designated function or activity but also from the general use of the college facilities, and agrees to pay for repair or restoration of damages to the facilities, excluding those which may rise from the stated and normal use, at an amount assessed by Portland Community College.

Submitted by:

Title

Date

Mail to :
Gail Nehilla
Bldg 7, Portland Community College/Rock Creek
17705 NW Springville Road
Portland, Oregon 97229

Group Name
Street Address
Address (cont)
City
State
Contact Person
Date(s) of Requested Use
Time(s) of Requested Use
Number of People
Phone
E-mail
Description of Requested Use
Instructions: Please read an then add addition information below: 1. The RCESC is an educational and research facility open to approved user groups. Access to all or part of the facility may be restricted at times in order to minimize the disturbance to wildlife and vegetation 2. There is no charge for the use of the facility unless, in the judgment of the coordinator, a PCC approved staff person is required for the requested use. 3.Users may not litter, collect or damage vegetation, unnecessarily disturb wildlife, or depart from approved pathways and trails. No bicycle use is allowed and no dogs other than approved guide dogs. 4. Users who require other facilities and services should complete a standard APPLICATION FOR THE USE OF COLLEGE FACILITIES & SERVICES to request them.
your group name	Indemnifies and holds harmless Portland Community College against all claims, losses or liabilities arising from the above use of the RCESC arising from but not limited to the actions of the designated function or activity but also from the general use of the college facilities, and agrees to pay for repair or restoration of damages to the facilities, excluding those which may rise from the stated and normal use, at an amount assessed by Portland Community College.
Submitted by:
Title
Date

Copyright © 2000 [RCESC of PCC]. All rights reserved. Revised: January 05, 2000

Copyright © 2000 [RCESC of PCC]. All rights reserved.
Revised: January 05, 2000