Pasadena Buddhist Temple
1993 Glen Avenue
Pasadena, CA 91103
(626) 798-4781
Facilities Use Form
Annex Building [Gym] Usage Suggested Donation Schedule:
[Gym Capacity: __________]
Youth Recreation
$30/hour
General Purpose Use
[Non Youth / Non Recreation]
$100/hour
$750/day
General Purpose use of Annex Building gatherings
includes use of tables and chairs, and stage. There will
be no use of heating / air conditioning. Temple will not
provide public address equipment.
Annex Kitchen:
$150/hour
Preparing and serving food
Annex Cleaning Deposit:
Annex [Gym]
Kitchen
$150
$150
The using organization shall clean the facility including kitchen, annex and exterior to original
condition. If cleaning is satisfactory to the Temple Board member or designated
Temple supervisor, the deposit will be returned. If the cleaning does not meet the satisfaction of
the Temple Board member or designated Temple supervisor, the deposit shall be retained by
Temple to pay for janitorial services.
Cleaning to include:
 Empty all trash cans in to large trash bin in rear parking lot, reline all trash cans;
 Return all chairs and tables to proper storage location;
 Wet mop floors; Sweep areas necessary;
 Check and clean restrooms;
 Wash and return kitchen utensils / pots, if used;
 Clean any outdoor areas to pre event conditions.
* Annex Insurance:
coverage required].
User will be required to provide proof of insurance [$500,000 liability
Classroom Usage Suggested Donation Schedule:
[Classroom Capacity ________]
Classroom Use
$20/hour
$100/day
Includes use of two classrooms.
Classroom Kitchen:
$75/hour
Preparing and serving food
Cleaning Deposit
Classroom
Kitchen
$100
$100
The using organization shall clean the facility, including exterior to original condition. If
cleaning is satisfactory to the Temple Board member or designated Temple supervisor, the
deposit will be returned. If the cleaning does not meet the satisfaction of the Temple Board
member or designated Temple supervisor, the deposit shall be retained by Temple to pay for
janitorial services.
Cleaning to include:
 Empty all trash cans in to large trash bin in rear parking lot, reline all trash cans;
 Return all chairs and tables to proper storage location;
 Wet mop floors; Sweep areas necessary;
 Check and clean restrooms;
 Wash and return kitchen utensils / pots, if used;
 Clean any outdoor areas to pre event conditions.
Classroom Use Insurance:
Upon Request.
Parking Lot Suggested Donation Schedule:
Entire Parking Lot
$600/week
$100/day
RV/ Lg. Truck/ Lg. Trailer
$90/month
Small vehicle/Sm. Trailer
$50/month
Vehicles must be available to move off temple property temporarily on days of temple
fundraising events if space is needed. In/out privileges limited due to parking lot gate maybe
locked.
Parking Lot Use Insurance:
Upon Request.
Facility Use Suggested Donation:
Please remit donation payable to Pasadena Buddhist Temple
Facility Use Request
Organization/Name:
_____________________________
Date
_____________
Organization Contact:
__________________________________________________
Responsible Party Representative __________________________________________
Address: _______________________________________________________________
Phone #: ______________________________
Email: _______________________
Date Requested / Time Period needed: ______________________________________
______________________________________________________________________
Activity / Event: ________________________________________________________
_______________________________________________________________________
Number of participants expected:
Facility Requested:
_________________________________________
[__] Annex [___] Classrooms [____] Annex Kitchen
[ ] Classroom Kitchen
_______________________________________________________________________
_______________________________________________________________________
____________________________________________________________________
______________________________________________________________________
Temple Member Reference : ______________________________________
Signature: ________________________________
Date: ____________________
Signer agrees to donate for use of facility, provide cleaning deposit and clean the
facilities as required per Facilities Use form.