HomeMy WebLinkAboutMH/IDD/EI - Conococheague InstituteThe Conococheague Institute - 12995 Bain Road, Mercersburg, PA, 17236 - 717 328 2800 -info@cimlg.org
Grounds Rental Form
Name of Individual or Group requesting the use of CI’s grounds:
________________________________________________________________
Requested Date(s): ______________________Time (From/To): _____________________
How Many People expected at your event: ________________________
Primary Contact Name: _______________Phone:__________Email:_________________
Reason for Request: Wedding ___ Corporate Event ___ Private Party ___ Family Reunion___ Training ___
Other (please specify) _________________________________________________________
List any Special needs your group may require (subject to approval by CI):
______________________________________________________________________________________________________
Rental Option Choice (see next page) and Fee:____________________________
Certificate of Insurance required (not applicable for private party and wedding rentals):
No _______Yes ________ (please send with Site Rental)
Use of CI grounds by organized groups holding public events require a Certificate of Liability Insurance. Certificates must name The
Conococheague Institute as additional insured. The CSL (combined single limit) is $1,000,000 dollars to cover Premises and
Operations liability for Bodily Injury and Property Damage. If it is determined that insurance coverage is necessary to hold your
event at CI, this contract will not be approved until the certificate is received. Please note that the need for insurance generally does
not apply to private party pavilion rentals for weddings. If there is any question as to the need for Liability Insurance, the contract will
be reviewed by CI.
I (we) request to use CI for the above described rental level. I (we) have read the included Rules and Regulations of CI and agree to
comply with them during use of these facilities. Reservation is approved when the rental fee is submitted with a contract and
reviewed/ signed by CI Management. I also understand that CI will only issue a refund in the event that the Site closes for that day.
The closing is at the discretion of CI’s staff and would have to involve a natural disaster, such as a flood that would endanger
participants. If my event is canceled for any other reason (renters choice) I (we) will not receive a refund of the Security Deposit or
Rental Fee. If both Security Deposit and Rental Fee have been paid, the Security Deposit will be returned.
Total rental fee due: _____________Date received: _____________
Insurance required? (No) (Yes) If Yes, date received: _____________
Renter’s Printed Name ________________________ Renter’s Signature ________________________ Date _________________
CI Representative’s Printed Name & Title ___________________ CI’s Signature _____________________ Date ____________
Security Deposit $_________ received on (date) ______________ by CI staff member _____________________________
Note: No reservation will be guaranteed until full payment is made. We accept cash, check, debit, or credit card and PayPal.
Reservations are on a first come, first serve basis. Please complete this form and return with payment to The Conococheague
Institute. Please be aware that CI is a public area. Other events and usage of the site will continue during your rental.
Franklin/Fulton MH/IDD/EI
9/30/26
75
Cori Seilhamer 717-264-5387 caseilhamer@franklincountypa.gov
standard $200
8am-4pm
meditation walk
N/A
$200.00
The Conococheague Institute - 12995 Bain Road, Mercersburg, PA, 17236 - 717 328 2800 -info@cimlg.org
Rental Options and Terms
Standard Rental - $200
This rental affords a full day use of designated area for private parties, family reunions, simple weddings etc. Area
includes Picnic tables, and 3 Wheelchair accessible bathrooms. If your group involves more than 100 people then
Portable Toilets must be rented at your cost
Historic Programming, Cabins and the Gift Shop will be available at request, and renters are free to explore the open
areas of the site, while understanding that other visitors may be present
Alcohol is permitted inside the designated area only,and the renters must follow local liquor laws (including
prohibiting underage drinking). Alcohol may be drunk but NOT SOLD. Any infraction of those laws will result in
immediate expulsion from the CI property. CI is not responsible for guests leaving the site while intoxicated.Please
drink responsibly. RENTER INITIAL ____
Additional Accessories (Lawn furniture, Tents, Marquees)may be placed in the Designated area, but must be
removed after the event by the Renter. Accessories will not be provided by CI
Decoration of the Gazebo and Birding Platform (for Wedding use or photography) is permitted 48 hours before the
event, but must be removed within 48 hours of rental.Decorations must meet applicable fire prevention codes and
may not be applied with any non-reversible technique.Delay in removal or damages will void the Security Deposit
All vehicles must park in an assigned parking area.Vehicles dropping off equipment or heavy loads may be stopped
near the rental area for 15 minutes, as long as it doesn’t impede traffic or damage the landscape.
Due to the immersive programming and its environment,Please keep the sound level of any electronic equipment
such as speakers, PA systems, etc, at the lowest level possible for your event, so as not to disturb other people using
the site. Your respect in keeping noise to a minimum is appreciated
Potable water is not available at CI, so please bring your own refreshments
Pets are permitted in outdoors areas, but must remain under control and on a leash at all times
Large Catered Event or Corporate Rental- $300-$500 (depending on guest numbers and space)
All of the above applies. In addition:
Additional designated areas to accommodate larger numbers of participants
Designated area for Catering Crews (All caterers must provide proof of insurance as well as any required Health
Department Certificates). Certificates should be sent to CI 45 days prior to the event.
Specific large event necessities must be discussed prior to rental on a case by case basis
Security Deposits are required and are equal to the amount of each rental: Security deposit must be paid when
reservation is made and secures your event’s date.The second amount due, which is for the rental fee,must be paid
within 30 days of your event. Failure to observe the information on the front of this form and/or site rules and
regulations will result in forfeiting this security deposit. After your event, we will promptly refund your security deposit,
approximately two weeks, pending an inspection by a CI staff person of the area rented. Any damage or cost of
clean-up will be deducted from security deposit.