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)________________________________________
Email:__________________________________________________________
Date of event: Duration of event:
Purpose of event: ______________________________________________________
Number of people expected to attend: ______________________________________
Arrival time (include set-up): ________ Departure time (include clean-up): ________
Room preferred:
Activity Room 1 Billiard Room
Activity Room 2 Computer Lab
Community Room
Town Hall Meeting Room Police Dept. Community Room
Reason for room specified: ____________________________________________________________________________________________________________________________________________
Equipment use requested: (lectern, projection screen, TV, VCR, kitchen, etc.): ____________________________________________________________________________________________________________________________________________
Name of Applicant:___________________________ Applicant’s phone:____________
Applicant’s address: _____________________________________________________
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
………………………………………………………………………………..
For office use only
Approved Yes _____ No _____ By_________________ Date____________
Deposit received Yes _____ No _____ By_________________ Date____________
Fee received Yes _____ No _____ By_________________ Date____________
Orientation Required Yes______ No______ By_________________ Date____________
Certificate of Insurance Yes______ No______ Faxed on____________ Date____________
Key needed Yes _____ No _____
Police notified Yes _____ No _____
Occurrence First_____ Second__ Third____
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