Form Center • Facility Use Request Form

Organization & Contact Information

Organization Name*
Contact First Name*
Contact Last Name*
Email Address
Phone Number*
Organization Address*
City*
State*
Zip Code*
Purpose of Facility Use*
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Facility Information

Desired Date & Time of Use*
Desired Date & Time of Use Start Date
Desired Date & Time of Use Start Time
—
Desired Date & Time of Use End Date
Desired Date & Time of Use End Time
Is this a recurring event? *
1. Yes
2. No
How often does the event occur?*
1. Weekly
2. Bi-weekly
3. Monthly
4. Quarterly
5. Other
How many people do you anticipate coming?*
Facility*
Historic Kenton County Courthouse
Outside use only. Located at 5272 Madison Pike in Independence.
Judge/Executive Conference Room
Fits 20 people. Includes WIFI, TV, phone, kitchen sink, refrigerator and outdoor space. Located on the fifth floor at 1840 Simon Kenton Way in Covington.
Government Center Huddle Room (3008)
Fits 4 people. Includes WIFI, TV and phone. Located on the third floor at 1840 Simon Kenton Way in Covington.
Government Center Conference Room (3007)
Fits 6 people. Includes WIFI, whiteboard, TV and phone. Located on the third floor at 1840 Simon Kenton Way in Covington.
Training Room
Fits 40 people. Includes WIFI, cable TV, whiteboards, projector, speakers, computer, refrigerator, microwave, and kitchen sink. Located on the second floor at 1840 Simon Kenton Way in Covington.
Kenton Chambers
Fits 62 people. Includes computer, projector, microphones and speakers. Located on the second floor at 1840 Simon Kenton Way in Covington.
Riedlin-Schott Community Room
Fits 136 people (tables and chairs). Includes WiFi, audio and visual capabilities. Located on the second floor at 1840 Simon Kenton Way in Covington.
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Legal Agreements

I attest or affirm that the information above is true and accurate to the best of my knowledge and I further acknowledge that if the facility is not returned to its original state after my use, I will be invoiced by the Fiscal Court for any maintenance or cleanup expenses associated with my use of said facility.*
1. I agree
By checking the "I agree" box below, you agree and acknowledge that: 1) your application will be submitted and considered without your handwritten signature; 2) that you are consenting to an electronic signature, which is the same as your handwritten signature for the purposes of validity, enforceability and admissibility; 3) that in lieu of an electronic signature, you may contact Kenton County Administration for a printable version of the application and submit it using your handwritten signature using either USPS or another delivery or courier service; 4), that your submitted application will be made available to you upon written request subject to applicable record retention guidelines.*
1. I agree

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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