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Chickasaw Nation Headquarters Gym Practice Session Application and (The Chickasaw Nation)

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Page 1 of 5 Form no. 04104 CS-P&F 8/2019
Chickasaw Nation Headquarters Gym Practice Session
Application and General Use Agreement
________________________________________________________________________________________
TO SECURE RESERVATIONS: COMPLETED APPLICATION ALONG WITH ROSTER SHALL BE TURNED
IN TO RECREATION OFFICE. ALL RESERVATIONS ARE FIRST-COME, FIRST- SERVED. NO DATES
WILL BE TEMPORARILY HELD.
________________________________________________________________________________________
Application and Information
(Please read the General Use Agreement prior to signing)
Head coach: (Head coach shall be present at all practices)
Name:
First Middle Last Suffix
Phone: Cell phone:
Address:
Street City State ZIP
Team name: Age group/gender:
Month: Email:
Goal Height: 10 ft. 8 ft.
Court: Half court Full court
---------------------------------------------------------------------------------------------------------------------------------------------------
Please attach copies of the following documentation with this form:
Chickasaw citizenship card (required) Driver’s license/photo ID
---------------------------------------------------------------------------------------------------------------------------------------------------
Head coach verification:
I verify that I am the head coach of the above named team.
Responsible party signature
Bill Anoatubby
Governor
Department of Community Services / Recreation Office
714 Orchard Street / Ada, OK 74820 / (580) 272-1108 / (580) 665-6047 After hours
Page 2 of 5 Form no. 04104 CS-P&F 8/2019
GENERAL USE AGREEMENT
Waivers and governing law:
The parties will use their best efforts to amicably resolve any dispute. However, nothing contained in this
Application and General Use Agreement shall be construed to waive the sovereign rights of the Chickasaw
Nation, its officers, employees or agents. This agreement shall be performed within applicable guidelines,
resolutions and statutes of the Chickasaw Nation. State law shall not be applicable nor shall disputes be
subject to any authority outside the Chickasaw Nation.
Disclaimer:
The Chickasaw Nation reserves the right to refuse the use of the Chickasaw Nation Gym (hereinafter gym) to
any person without stating the reason for doing so, and reserves the right to impose special conditions where
the nature of the use, in the Chickasaw Nation’s opinion, so demands. Recreation staff will be responsible for
the general oversight of the gym at all times. However, the individual and/or organization signing this
Application and General Use Agreement shall be the responsible party, herein responsible party, and shall
assume the complete responsibility for, and hold the Chickasaw Nation harmless from, any and all damages,
losses or injuries during the practice session. The responsible party shall also assume all responsibility for any
support materials or equipment for the practice session. Practice sessions held at the gym do not represent the
position of the Chickasaw Nation. *THE CHICKASAW NATION IS NOT RESPONSIBLE FOR ACCIDENTS*
First aid cabinet:
A first aid cabinet is located in the concession area. The Chickasaw Nation expressly disclaims responsibility,
and shall have no liability, for any damages, loss, injury or liability whatsoever suffered as a result of the use of
the first aid cabinet. The first aid cabinet is not intended to replace emergency medical care. Should an
emergency arise, please call 911.
AED cabinet:
An automatic external defibrillator (AED) cabinet is located in the concession area next to the first aid cabinet.
The Chickasaw Nation expressly disclaims responsibility, and shall have no liability, for any damages, loss,
injury or liability whatsoever suffered as a result of the use of the AED. The AED is not intended to replace
emergency medical care. Should an emergency arise, please call 911.
Reservations:
Each team may reserve the gym up to one month in advance. One agreement per team head coach may be
submitted by the team’s responsible party. The team’s responsible party will be the team head coach, who is
also a Chickasaw citizen. All reservations are first-come, first-served. Each team is allowed one practice time
slot per week for half court or two full court slots per month. Full court slots cannot be reserved in the same
week. Time slots will be one hour or 60 minutes in duration and be on either the north or south half of the court,
unless the full court option is selected. Special requests to reserve the gym outside of this time frame are
subject to review by the executive officer or designee. The team’s responsible party requesting the reservation
will be the sole point of contact for the practice sessions.
Available practice times:
Tuesday & Thursday
5:30 p.m., 6:30 p.m., 7:30 p.m. and 8:30 p.m. (one hour in duration each)
*NOTE: The 1
ST
and 3
rd
Tuesday of every month may be reserved for Chickasaw Nation events and no
practice may be reserved.
In-season/out-season
In-season will be from September through March and follow guidelines listed in the reservations section of this
general use agreement. Out-season will be from April through August. During out-season, practices will
change from half court practices to full court practices once per week, with all else remaining the same.
Cleaning:
At the end of each practice, all trash at the gym location shall be picked up, which includes trash in and around
the court, seats and general area. Trash should be disposed of in the nearest dumpster.
Page 3 of 5 Form no. 04104 CS-P&F 8/2019
Cancellations:
Cancellations shall be given by the head coach at least 24 hours prior to the practice session to reschedule
within the same week (when available). The responsible party will not be allowed to reschedule another time
slot if notification was not given. The executive officer or designee reserves the right to cancel future practice
sessions for a responsible party that repeatedly fails to give cancellation notices. Repeated cancellations
without notification may result in losing rights to reserve the gym. HEAD COACHES ARE EXPECTED TO BE
PRESENT AT ALL PRACTICES. Head coaches are required to be present at 75% of team’s practice
sessions. For extenuating circumstances that do not allow the head coach to be present for his team’s
scheduled practice session, an alternate coach may be selected so that the practice will not have to be
cancelled/rescheduled. Repeated absences by the head coach may result in future practices being cancelled
and/or loss of privileges to reserve the gym for a time period designated by the executive officer or designee.
Damages/repairs:
Any Chickasaw Nation-owned equipment or other property destroyed, stolen or abused during a licensee’s
event practice session shall be replaced and/or repaired by licensee within 30 days. The cleaning deposit of
$50 may be retained until such repairs are made or to cover the losses or damages to the complex, its material
or equipment. The Chickasaw Nation reserves the right to seek any and all legal redress against the licensee
for losses or damages above and beyond fifty dollars.
Jurisdiction:
This Chickasaw Nation Gym Application and General Use Agreement and any accompanying documents shall
be performed within applicable guidelines, resolutions and ordinances statutes of the Chickasaw Nation. State
law shall not be applicable nor shall disputes be subject to any authority outside the Chickasaw Nation. The
parties will use their best efforts to amicably resolve any dispute. However, nothing contained in this form or
any accompanying documents shall be construed to waive the sovereign rights of the Chickasaw Nation, its
officers, employees or agents. Licensee, and its participants, hereby consent and agree to the personal
jurisdiction of the Chickasaw Nation for any disputes arising from the licensee’s event, this form or any
accompanying documents.
General rules and regulations:
1. The head coach shall be a Chickasaw citizen and is expected to be at all scheduled/approved practices.
2. The practice session time begins and ends as indicated by the time slot(s) selected and approved. Please
enter and leave the gym at the scheduled time. Failure to do so may result in future practices being
cancelled.
3. No unlawful, offensive or political activities on the premises.
4. No alcoholic beverages, tobacco, illegal drug and/or firearms will be allowed on the premises. “Tobacco”
includes any form of electronic cigarette, atomizing or vaporizing inhalation device whether or not it
contains actual tobacco.
5. All children under 16 years of age shall be accompanied by a responsible adult.
6. Glass containers are not allowed in the gym or the surrounding area.
7. No pets are allowed, except service animals or special program animals (e.g., police canine).
8. Urinating or defecating in the gym or the surrounding area is strictly prohibited except in restrooms; urinals
and/or toilets are provided in each restroom for that purpose.
9. The Chickasaw Nation reserves the right to control the management of the gym, and to enforce all
necessary and proper rules for management and operation of the gym, through its executive officer,
director, police, fire and other designated representatives.
10. No heels, boots or other abrasive shoes will be allowed on the basketball court. To protect the finish of the
basketball court– athletic shoes are preferred.
11. Participation in any physical activity has possible inherent and unforeseen risks which include injury or
death. Anyone attending practice sessions and/or using the gym assumes all risks and shall be responsible
for taking proper precautions. THE CHICKASAW NATION IS NOT RESPONSIBLE FOR ACCIDENTS.
Page 4 of 5 Form no. 04104 CS-P&F 8/2019
Closures:
1. The gym may be closed or its use limited by the executive officer or his designee to ensure the safety and
security of the public and/or Chickasaw Nation property when fire hazards, inclement weather or other
hazards exist.
2. No person shall refuse an order to evacuate the gym property in time of an emergency or when ordered to
do so by an officer of the Chickasaw Lighthorse Police Department or the executive officer or his designee.
Indemnification and hold harmless:
The responsible party shall indemnify and hold harmless the Chickasaw Nation, its employees and agents,
from and against any claims, demands, losses, damages or expenses relating to bodily injury or death of any
person or damage to real and/or tangible personal property, incurred while the responsible party is engaged in
activities arising out of the Application and General Use Agreement and to the extent proximately caused by
the negligent or willful acts or omissions of the responsible party, its invitees, participants, guests or agents in
the performance of such activities.
Waiver and Acknowledgement
I am the responsible party and authorized person in charge of the practice session(s) scheduled at the
Chickasaw Nation gym for a practice session and I declare that all rules, regulations and payment as described
in the Application and General Use Agreement and I agree to be bound by the same. Further, I agree that I am
solely responsible for the practice session(s) and hold harmless the Chickasaw Nation, the Chickasaw Nation
Recreation Program, its employees or representatives from any and all claims for liability of injury, damages or
loss of property that may result from any act or omission on the part of the responsible party or its agents,
participants or guests while using the gym. I have read, received a copy of, and agree to the Application and
General Use Agreement. I confirm that I am authorized to accept such terms and conditions on behalf of the
organization listed.
Print name: Date:
Signature:
Organization: or team:
Authorization:
Staff print name: Date:
Staff signature:
Approved Practice Date and Times
1
st
week: Date: _______________ Time: _______________ Court: North South Full
2
nd
week: Date: _______________ Time: _______________ Court: North South Full
3
rd
week: Date: _______________ Time: _______________ Court: North South Full
4
th
week: Date: _______________ Time: _______________ Court: North South Full
Date completed application received:
Approved by:
Recreation staff name
NOTE:* If full court option is selected, only two time slots will be approved, during “in-season” only. During “out-season” all four time
slots may be approved.
Recreation Office
Page 5 of 5 Form no. 04104 CS-P&F 8/2019
714 Orchard Street
Ada, Oklahoma 74820
Phone: (580) 272-1108
Phone – after hours: (580) 665-6047
Team Roster
Head coach: Month:
Team name: Date:
Age group: Gender:
Players
Practice session () If
present
Last name
1st
2nd
3rd
4th
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Head coach signature
1st: Date:
1st: Date:
1st: Date:
1st: Date:
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Completed 31 January 2021

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