2. 

3. Town of Shady Shores

   101 S. Shady Shores Rd

   Shady Shores, TX 76208

   940-498-0044

   
   

5. Town Hall /  Community Center

   Rental Refund Request

   
   

7. Please complete the following information.
9. Contact Information
11. Contact Name:
12. Organization Name:
14. Address:
16. City:
17. State:
18. Zip:
20. Phone Number:
21. Email Address:
25. Date of Event
29. Checklist

    The following items were restored to original condition

31. Chamber Hall

    1. Chamber Hall

    • Return chairs to original position
    • Return tables to original position
    • Table clothes and items returned to table tops, as found
    • Floor is clear of major debris
    • Trash collected and deposited to proper cans (outside backdoor)
    • Any damage noted to Town Hall

    Rental Fees:

    $100.00 for up to 6 hours (for Shady Shore residents)

    $300.00 for up to 6 hours (for non-residents)

    $15.00 per hour thereafter

    $200.00 Deposit. 

32. Community Room

    1. Community Room

    • Return chairs to original position
    • Return tables to original position
    • Floor is clear of major debris
    • Trash collected and deposited to proper cans (outside backdoor)
    • Any damage noted to Town Hall

    Rental Fees

    $50.00 for up to 6 hours; included in Chamber Hall fee if rented together

    $15.00 per hour thereafter, up to 3 hours

    $50.00 deposit

33. Kitchen

    1. Kitchen

    • Counters are clear of parties property
    • Counters are wiped down
    • Sink is empty
    • Floor is clear of major debris, brooms are found next to refridgerator
    • Refridgerator and Freezer are clear of parties items
    • Staff items have been placed back on counters as found (if moved for party needs)
    • Trash collected and deposited to proper cans (outside backdoor)
    • Any damage noted to Town Hall
35. 
36. 
37. 
38. 
40. Scan Card was returned to Town Hall*

    1. Scan Card Returned: Date______________ Location: ________________

    Scan card may be dropped off with this form in the dropbox (front sidewalk of Town Hall)

    or returned with this form during normal business hours. 

42. Front Door Deadbolt and Side Door Deadbolt are in locked position

    1. Yes
46. The facility must be returned to the same condition as before access occurred. *

    1. By clicking this box, I agree the facility has been restored to original condition

    This includes moving the furniture back to its original location and removal of any and all personal belongings. The event holder guarantees reimbursement to the Town for any damages to the facility, fixtures, furniture, appliances, equipment, etc. caused during the event. 

50. Office Use Only

    1. Refund Forms Completed
    2. Staff Walk Through Complete
    3. Refund Approved
51. Fees Refunded

    Rental Amount $ ______________________

    Deposit Amount $_______________________

    Refunded Amount $_______________________

    Method of Refund

    • Returned Renter's original payment (cash or check)
    • Town Hall issued:

    Check #

    Payable to: ______________________________

    Date: ____________________________________

    Deductions made for: ____________________

    ______________________________________

    ______________________________________

    
    

    
    

53. Date Approved:
    Date Approved:

    Date Approved:
55. Approved By:
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit Submit and Print

* indicates a required field