Town of Granby
Town Hall Meeting Room, Police Department Community Room, Senior Center/Youth Services Building
Room Use Request
Town Hall and Police Dept. Senior Center/Youth Service
Phone: (860) 844-5300 Phone: (860) 844-5350
FAX (860) 653-4769 FAX (860) 844-8848
Name of person/group /organization:_________________________________________________________
Contact person:_________________________________________________________________________
Phone number: (between 9am-4pm) ___________________________________________________
Phone number: (after hours)__________________________________________________________
Date of event:___________________________________________________________________________
Arrival time (include set-up): ________ Departure time (include clean-up): __________
Number of people expected to attend: ________________________________________________________
Purpose of event/reason for room specified: ___________________________________________________
Room preferred:
Senior Center - Activity Room 1
Senior Center - Activity Room 2
Senior Center - Community Room (weekend rental - if available)
Town Hall Meeting Room
Police Dept. Community Room
Room set up required: yes____(please attach set up) no_______
Name of Applicant:___________________________ Applicant’s phone:____________
Applicant’s address: _____________________________________________________
Signature of Applicant:_________________________
Date:______________
THE APPLICANT AGREES TO FOLLOW THE GUIDELINES ESTABLISHED BY THE TOWN OF GRANBY HOLD HARMLESS AGREEMENT: User agrees that it will indemnify and hold harmless the Town and its respective officers, agents and employees from any loss, cost, damage, expense and liability whatsoever kind or nature resulting directly or indirectly from the nature of use covered by this contract which results in bodily injury including death, personal injury or damage to property. ____________________________________ Signature of Applicant |
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For office use only
Approved Yes______ No______ By_________________ Date___________
Deposit/fee received* Yes______ No______ By_________________ Date___________
Certificate of Insurance Yes______ No______ Faxed on____________ Date____________
Police notified Yes _____ No _____
Occurrence First_____ Second__ Third____
*Amount of Deposit __________________ *Amount of other Charges:_____________ Staff Initials
Input:_____________ Calendar:____________________
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