Application for Community Room Use

Meeting or Event Purpose (be specific)*
Date of Meeting*
Beginning Time*

: HH

MM
Ending Time*

: HH

MM
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 60" Round Tables Needed (seats 8-10 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.

Rhythm & Movement Story Time
10:00 AMEnds on: Friday, January 24, 2020 11:00 AMWhere: Middlebury Community Public Library at Room 2 & 3
NOTE: IF YOU ARE REGISTERING MULTIPLE CHILDREN, PLEASE REGISTER YOUR FAMILY AS A GROUP. FOR EXAMPLE, MS. BETH HAS 2...
Location: Middlebury Community Public Library at Room 2 & 3
Chess Club
6:00 PMEnds on: Monday, January 27, 2020 7:00 PM
Join Derek Yoder as he leads our very popular Chess Club. Regardless of your playing level, you are welcome to...
Location: Middlebury Community Public Library at Room 2 & 3

Applicant Making Request