Waiver Request Authorization Form
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1
2Waiver Request Authorization Form
For On-Campus Food and/or Catering Services
(This form must be submitted ten (10) business days prior to the event for approval)
Contact/Event Coordinator: ____________________________
Contact Phone #: _______________________
Vendor Name:
__________________________________
Contact Fax #:
_______________________
Department Name: __________________________________
Contact E-mail:
_______________________
Name of Event:
__________________________________
Event Date:
_______________________
to
Event Location:
__________________________________
Event Hours:
_______________________
Please check all that apply:
Students:
Faculty/Staff:
Public/Other:
Approximate number of people to be served:
Attachments: UHCL Dining Quote:
Outside Vendor Quote:
Justification for waiver request:
It is hereby agreed that the aforementioned department will indemnify and hold harmless the University of Houston-Clear Lake
from any claims or actions which may arise from the food at the event described herein, and that you agree to properly refrigerate
and hold all perishable items.
Event Coordinator: Signature: __________________________________________________ Date: __________________
__________________________________________________
(Print Name Here)
University Dining Services Office Use Only
Waiver Approved:
Reasons for Approval:
Waiver Denied:
Reason for Denial:
Approved By: ______________________________________
Date: _________________________________
(Print Name Here)
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Parent category: Legal