Application for Community Room Use

Meeting or Event Purpose (be specific)*

Date of Meeting*

Beginning Time*

:

Ending Time*

:

Number in Group (50 per room, 150 maximum)*

No. of Rooms Requested (1, 2 or 3)

Kitchen Access ($25.00 suggested donation)*

Number of 6'x30" Rectangle Tables Needed (seats 6-8 adults)

Number of Chairs Needed

Applicant Making Request

Name*

First Last

Address

City State / Province / Region ZIP / Postal Code

Phone*

Rules and Conditions*

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.

I agree to the Rules and Conditions.

Date

Applicant Making Request

Services

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