Application for Use of Facility

Organization Name: _________________________________________

Purpose for the Group/Organization: ___________________________________________________________

_________________________________________________________________________________________

Sponsoring Organization Contact:

Name: __________________________________________________________

Street Address: ___________________________________________________________________________

City: ___________________________________________ State: _____________ Zip: __________________

Telephone: ________________________________________________________

Email: ____________________________________________________________

Individual Submitting Application (if different from above):

Name: ____________________________________________________________

Telephone Number: __________________________________________________

Proposed Use of Requested Facility: __________________________________________________________

____________________________________________________________________________________________________

_____________________________________________________________________________________________________

Will Food and/or Beverage Be Served:  Yes _______     No _______

Will any Outside Equipment Be use to Facilitate this Meeting?   Yes _______     No _______
If yes, List All Equipment: ________________________________________________________________

____________________________________________________________________________________________________

Does a Certificate of Insurance Accompany this Application?  Yes _______     No _______

The undersigned user of the meeting room has read the St. Joseph Public Library Meeting Room Policies and understands and agrees to abide by the guidelines and rules described therein.  Failure to abide by these rules may disqualify the organization from future use of the rooms as a minimum penalty.

The Library is not responsible for lost or stolen items.  Damages to the premises, equipment, or furnishings as a result of meeting room use will be charged to the group responsible.  The group or organization and its members, jointly and serverally, will assume and bear full responsibility for loss, or injury, or damage to any property of the St. Joseph Public Library caused by the organization, its members, affiliated persons, guests or invitees.

Every person, group, or organization using library facilities shall indemnify, hold harmless, and defend the library, its Board of Directors, and its employees from any and all liability or financial loss, costs, or expenses (including reasonable attorney’s fees and legal costs) resulting from any suits, claims, losses, or actions brought against the library and/or employees which result directly or indirectly from wrongful or negligent actions of permittee including its sponsor(s), spectators, participants, members, officers, directors, or agents.  Wrongful or negligent actions include, but are not limited to, failure to adequately inspect, discover and remedy, or warn of defect in the premises or grounds.

Applicant’s Authorized Representative:

Name (print): _____________________________________________________________________________

Date: __________________________________________________

Signature: _______________________________________________________________________________