Ho-Chunk Nation Phone #: 608-277-9964 FAX #: 608-277-9965
Teejop Hocira 4724 Tradewinds Parkway, Madison WI 53718
FACILITY USE REQUEST
The Purpose of the Ho-Chunk Nation Teejop Hocira use Policy is to designate RESPONSIBILITY, to retain the
Teejop Hocira building cleanliness and maintenance for all who use the facility.
Name of Applicant requesting: __________________________________________________________
Mailing Address: _____________________________________________________________________
Phone #/Contact Number: _____________________________________________________________
Approximate number of people: _______________________________________________
PURPOSE/TYPE OF EVENT: _____________________________________________________________
DATE OF EVENT/ACTIVITY: _____________________________________________________________
Check Requested: KITCHEN LARGE CONFERENCE RM GYM SM CONFERENCE RM
SET UP TIME: ________________
TIME OF EVENT:__________________
EVENT END TIME: _______________
“CLEAN UP” END TIME: _______________
Applicant assures competent adult supervision of the function in and around the building.
Applicant assures all responsibility for personal liabilities.
Applicant responsible return of Key(s) to Branch Office staff following weekday of weekend use.
Applicant is responsible for Cleaning of the building. (See checklist – 2
nd
page)
Applicant is responsible for All Lights to be turned off when done with function/Event.
Applicant is responsible for All Teejop Hocira building doors to be checked, shut and locked when done with
function/Event.
No tape/glue or other adhesive material used on walls or painted surfaces.
AGREEMENT
I hereby agree to comply with all rules as listed. I also agree that I understand it is my responsibility to ensure the
Facility Request check list (2
nd
page) is completed and keys are returned to Teejop Hocira Madison Branch office staff.
Signature of Requesting Party: ____________________________________________________ Date: _____________
Approved Denied Admin. Staff Signature: ______________________________ Date: _______________
OFFICE USE ONLY:
DATE RECEIVED: ______________ TIME RECEIVED: ______________ STAFF INITIALS: ________
Teejop Hocira Phone #: 608-277-9964 FAX: 608-277-9965
