House Request Form

Conditions of Use

All individuals and organizations requesting the use of the Black House facilities agree to the following guidelines:

• All requests must be made at least three days in advance.
• Alcohol, smoking, and the use of illegal substances are prohibited at all times.  
• The Black House must be returned to its original condition immediately after the conclusion of an event.  Organizations will be held liable for any damage done during their reservation.
• Any items left after an event will be held in the Black House for a period of up to three weeks to be claimed.  At the end of three weeks, all items will become property of the Black House and donated to the proper campus charity drives or disposed of as necessary.
• Food, beverages, and service items that are property of the Black House may not be used at any time without prior permission.  The organizer of the event will be notified in advance of any items donated for use by the Black House.  Individuals may not take or use items in the cabinets or refrigerator at any time.
• Unless prior permission is given, individuals should not save any personal items to the Black House computer hard drives.  Additional programs should not be downloaded or installed.  Any programs/files found will be automatically deleted.
• The noise level in the House must be kept at a reasonable level at all times.  
  

Violation of any of the above conditions warrants a fine of $25-$100 and the possible denial of any future reservation requests.  Otherwise, there is NO CHARGE to use Black House facilities.

Please fill out the following form to request the Black House for your event:

Your Name:
Your E-mail Address:
Dorm Phone:
Cell/Other Phone:
Organization:
Cost Center #:
Event Name:
Event Date:
Start/Preparation Time:	AM PM
End/Clean Up Time:	AM PM
Purpose of Use:	Social Event Organization Board Meeting Small Gathering Other
# of participants:
Areas Requested (Check all that apply):
Living Room    Dining Room     Kitchen       Basement/Computer Lab
Equipment Requested (Check all that apply):
TV/VCR             Chairs                  Pots/Pans       Computers

 

                Other Notes/Comments/Information (optional):

 

 

I have read and agree to the terms and conditions outlined above to use the Georgetown University Black House.  I understand that the submission of this request form does not guarantee the availability of the Black House for my event and that I will be contacted by the Resident Director regarding its status.  I further agree to the ramifications outlined above and, in the event that my organization does not fulfill its obligations, I authorize the Black House to fine my organization appropriately.

Electronic Signature:
Today's Date:

   

*Upon clicking submit you will be redirected to the home page of the Center for Multicultural Equity and Access.  You will receive a response to your request as soon as possible.  If you do not receive a response within three days of your submission, please contact the Black House Resident Director.