Application For Community Room Use

*Required fields

Name of Group         

Primary Purpose of Group and it's Functions

Date of Meeting*                       

Beginning and Ending Times*       

Number in Group (150 Maximum)    

Number of Rooms requested*   (1, 2 or 3) 

Do you need the kitchen?   

Number of Tables Needed  

Number of Chairs Needed  

Applicant making Request


Title / Position   


City, State / Zip 

Phone or Email*   

The applicant, on behalf of the above organization, acknowledges that he or she has read and agrees to comply with the rules governing public use of the community room located at the Middlebury Community Public Library.  The applicant accepts full responsibility for any damage to the Library's facilities or equipment during such use.  The applicant further agrees to hold harmless, release and indemnify the Middlebury Community Public Library and the Town of Middlebury from any and all claims, losses, damages, or lawsuits for damages, arising in any way whatsoever from, allegedly arising from or related to the use of the Library's facility hereunder by the organization.