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["※資料⑬\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和 ３ 年",null,null,null,null,null,null,"月",null,null,"日"]
["まろにえホール利用届出書【第50回市民文化祭】"]
["まろにえホール管理責任者宛",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（警備等含む施設・設備利用に関する届出書）"]
["（東久留米市立生涯学習センター）"]
[]
["実行委員氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"実行委員電話番号"]
["フリガナ"]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※配布物がある場合"]
["本番\n催事名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"の集い",null,null,null,null,null,null,null,"チラシ等挟込",null,null,null,null,null,null,null,null,null,null,"駐車場確保"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"可",null,null,"不可",null,null,"挟込者",null,null,null,null,"有り　　↓",null,"無し"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"センター",null,"団体"]
[]
["本番\n開場時間",null,null,"　　　　　　時　　　　　分",null,null,null,null,null,null,"本番\n開演時間",null,null,null,"　　　　　　時　　　　　分",null,null,null,null,null,null,"本番\n終演時間",null,null,"　　　　　　時　　　　　分",null,null,null,null,null,null,null,null,"No.1    No.2    No.3"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※上記の場所以外は確保できません"]
[]
["入場者　予定数",null,null,"名",null,null,null,null,"物品販売",null,null,"無し",null,null,"有り",null,"内容"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※別途、申請書要提出"]
["楽器使用",null,null,null,"備品使用"]
["有",null,"無",null,"有",null,"無"]
[]
[]
[null,null,"☐本番　☐リハ・仕込み",null,null,null,null,null,null,null,null,null,null,null,null,null,"☐本番　☐リハ・仕込み",null,null,null,null,null,null,null,null,null,null,null,null,null,"☐本番　☐リハ・仕込み"]
[]
[null,null,"令和３年　　月　　日（　　）",null,null,null,null,null,null,null,null,null,null,null,null,null,"令和３年　　月　　日（　　）",null,null,null,null,null,null,null,null,null,null,null,null,null,"令和３年　　月　　日（　　）"]
[]
[null,null,"使用予定時間：",null,null,null,null,null,null,null,null,null,null,null,null,null,"使用予定時間：",null,null,null,null,null,null,null,null,null,null,null,null,null,"使用予定時間："]
[]
[]
[null,null,"ホール",null,null,"午前",null,null,"午後",null,null,"夜間",null,null,null,null,"ホール",null,null,"午前",null,null,"午後",null,null,"夜間",null,null,null,null,"ホール",null,null,"午前",null,null,"午後",null,null,"夜間"]
[null,null,"ホール椅子",null,null,"椅子あり",null,null,"椅子あり",null,null,"椅子あり",null,null,null,null,"ホール椅子",null,null,"椅子あり",null,null,"椅子あり",null,null,"椅子あり",null,null,null,null,"ホール椅子",null,null,"椅子あり",null,null,"椅子あり",null,null,"椅子あり"]
[null,null,null,null,null,"フラット",null,null,"フラット",null,null,"フラット",null,null,null,null,null,null,null,"フラット",null,null,"フラット",null,null,"フラット",null,null,null,null,null,null,null,"フラット",null,null,"フラット",null,null,"フラット"]
[]
[null,null,"楽屋 1",null,null,"午前",null,null,"午後",null,null,"夜間",null,null,null,null,"楽屋 1",null,null,"午前",null,null,"午後",null,null,"夜間",null,null,null,null,"楽屋 1",null,null,"午前",null,null,"午後",null,null,"夜間"]
[null,null,"楽屋 2",null,null,"午前",null,null,"午後",null,null,"夜間",null,null,null,null,"楽屋 2",null,null,"午前",null,null,"午後",null,null,"夜間",null,null,null,null,"楽屋 2",null,null,"午前",null,null,"午後",null,null,"夜間"]
["パーテーション",null,"学習室1",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,"パーテーション",null,"学習室1",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,"パーテーション",null,"学習室1",null,null,"午前",null,"午後1",null,"午後2",null,"夜間"]
["開","閉","学習室2",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,"開","閉","学習室2",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,"開","閉","学習室2",null,null,"午前",null,"午後1",null,"午後2",null,"夜間"]
[null,null,"学習室3",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,null,null,"学習室3",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,null,null,"学習室3",null,null,"午前",null,"午後1",null,"午後2",null,"夜間"]
[null,null,"学習室4",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,null,null,"学習室4",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,null,null,"学習室4",null,null,"午前",null,"午後1",null,"午後2",null,"夜間"]
[null,null,"学習室5",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,null,null,"学習室5",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,null,null,"学習室5",null,null,"午前",null,"午後1",null,"午後2",null,"夜間"]
[null,null,"創作室",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,null,null,"創作室",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,null,null,"創作室",null,null,"午前",null,"午後1",null,"午後2",null,"夜間"]
[null,null,"音楽室",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,null,null,"音楽室",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,null,null,"音楽室",null,null,"午前",null,"午後1",null,"午後2",null,"夜間"]
[null,null,"料理室",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,null,null,"料理室",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,null,null,"料理室",null,null,"午前",null,"午後1",null,"午後2",null,"夜間"]
[null,null,"和室",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,null,null,"和室",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,null,null,"和室",null,null,"午前",null,"午後1",null,"午後2",null,"夜間"]
[null,null,"保育室",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,null,null,"保育室",null,null,"午前",null,"午後1",null,"午後2",null,"夜間",null,null,null,null,"保育室",null,null,"午前",null,"午後1",null,"午後2",null,"夜間"]
[]
[null,null,"鍵の責任者：サークル名・氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,"鍵の責任者：サークル名・氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,"鍵の責任者：サークル名・氏名"]
[]
[null,null,null,null,null,null,null," "]
["催事総合責任者",null,null,null,null,null,null,null,"氏名",null,null,null,null,null,null,null,null,null,null,null,null,"本番舞台責任者",null,null,null,null,null,null,null,null,"氏名"]
[]
[]
[]
["本番以外舞台担当",null,null,null,null,null,null,null,"氏名",null,null,null,null,null,null,null,null,null,null,null,"※本番と担当者が違う場合ご記入ください"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※火気危険物取り扱いがある場合ご記入下さい"]
[]
["火気・危険物利用",null,null,null,null,null,"無し",null,"有り",null,"内容",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"責任者",null,null,"氏名"]
[]
["※下記、開催当日常時配置される人数をご記入ください。入れ替わりは可能ですが記載人数は当日必須になります。"]
[]
["ホール内担当",null,null,null,null,null,null,null,null,null,null,"名",null,null,"ロビー担当",null,null,null,null,null,null,null,null,null,null,"名",null,null,"舞台担当(責任者除く)",null,null,null,null,null,null,null,null,null,null,"名"]
[]
[]
["楽屋回り担当",null,null,null,null,null,null,null,null,null,null,"名",null,null,"その他",null,null,null,null,null,null,null,null,null,null,"名"]
[]
[]
["施設ご利用上の注意"]
[]
["●","利用禁止事項"]
[null,"①営利を目的　②特定の政党または宗教の利害にかかわるもの　③センターの管理上支障のあるもの　④公の秩序を害し風俗を乱すおそれのあるもの　⑤施設を損傷する恐れのあるもの　⑥その他教育委員会が不適当と判断したもの"]
[]
["　　　"]
["●","定員数の厳守"]
[null,"決められた定員数を超えて入場させることは、消防法等により禁止されています。"]
["●","施設のキャンセル"]
[null,"お支払いが完了した施設使用料は返金できません。ただしホールの場合は利用日の一か月前、他貸室は利用日の前日までのキャンセルお申し出により半額返金致します。"]
["●","ホール等の利用時間"]
["　　","準備日及び当日を含めご利用許可のあるスペースは、９：００～２２：００を超えての利用はできません。"]
["　　","ご利用当日はあらかじめ許可された使用時間内に準備・片付け等を含め全てを終了させてください。"]
["●","入場料の有無"]
[null,"入場料を徴収する場合、金額や販売方法等担当者までお知らせください。この場合ホール等の利用料金が変わります。"]
["●","付帯設備・楽屋使用料の支払い"]
[null,"付帯設備使用料、楽屋使用料はホール利用の当日に当センター窓口にてお支払いください。"]
["●","駐車場のご利用制限"]
[null,"関係者の駐車スペースは準備日及び当日を含め、第２駐車場No.１～No.３の３台分までご利用いただけます。必要な車両数をお申し出ください。"]
["　　"]
["●","整理・誘導"]
[null,"ご来場者様の案内・整理・誘導は主催者様で行います。入場開始前に非常口・避難経路等を確認してください。"]
["●","災害発生時"]
[null,"災害発生時にはセンターの指示に従い、入場者の避難・誘導を行ってください。"]
["●","喫煙・飲食"]
[null,"施設内は全て禁煙です。また飲食(ロビーは可)もできません。当日はアナウンス等を用い来場者にもお知らせしてください。"]
["●","消耗品類"]
[null,"催事に必要な消耗品類は全て主催者様がご用意ください。"]
["●","お客様への案内"]
[null,"問い合わせ等の連絡先は必ず主催者様等の電話番号をご案内ください。"]
["●","病人・人身事故の発生時"]
["　　","病人又は不測の人身事故が発生した場合は、速やかに管理事務室までご連絡ください。"]
["●","終了時の点検・ゴミ処理"]
[null,"催事が終了しましたら、会場内他利用個所に忘れ物・落とし物がないかご確認ください。忘れ物等は主催者様にお持ち帰りいただき、清掃をお願いします。ゴミの処理は主催者様で行ってください。"]
[]
["●","専門技術者の配置"]
[null,"当センターの技術者は「舞台担当１名」、「音響担当１名」の計２名です。催事の内容によっては専門の技術者の増員が必要な場合があります。追加の費用については主催者様のご負担となります。また、追加の技術者の手配を主催者様側で行うこともできます。この場合も費用については主催者様のご負担となります。"]
["　　"]
["　　"]
["●","設備・電源等"]
[null,"ホール内の舞台設備や電源、備品等のご利用は必ず当センター常勤の専門技術者の指示に従ってください。必要なもの以外には一切触れないようにしてください。"]
["　　"]
["●","破損・故障"]
["　　","備品や装置などに破損や故障が発生した場合、速やかに専門技術者かスタッフまでお知らせください。"]
["●","物品販売"]
["　　","催事に関係するものに限り販売することができます。別紙、申請書を事前に提出してください。"]
["●","火気等の利用"]
[null,"演出効果でのローソクやマッチ、スモークマシーン等の火気類・危険物をご利用の際には、消防署等に届出が必要な場合があります。"]
[]
["●","お荷物の管理"]
[null,"お荷物等は原則お預かりできませんので、当日主催者宛てに届くようにしてください。"]
[]
[null,"本公演に際し、本書の利用注意事項を守り、主催者として責任をもって履行します。なお、届出事項に違反、または非常事態等が発生した際に、直に公演を中止・中断せざるを得ない場合でも一切の異議申し立ては行いません。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"  承認",null,null,null,null,null,"　確認",null,null,null,null,"案内担当"]
[]
[]
[]
[null,"□　上記注意事項を確認・同意の上、利用申請します"]
[null,"ご署名"]