Meeting Room Request Form

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Seekonk Public Library
Meeting Room Request Form

Date(s) Requested:________________________   Meeting Time is from__________ to __________

Organization’s Name: _________________________________________________________________

Purpose of Meeting: __________________________________________________________________

__________________________________________________________________________________

Please attach a brief description of your organization. [You may attach other printed materials.]

Please check the boxes  that apply to your organization:

__  Has previously used the library       __  Is a non-profit organization          __  Plans to serve refreshments

__  Membership is predominately from Seekonk     __ Can provide a certificate of insurance

By signing this request, I acknowledge that I have received, read and fully understand the Seekonk Public Library’s Policy and Regulations for the use of the Seekonk Library Meeting Room. I agree to assume personal responsibility for my organization’s compliance with these regulations, the behavior of all those attending any meeting or program, and the care of the meeting room and all library property within the room. As the individual or the accredited representative of the organization making the reservation, I agree to indemnify and hold harmless the Seekonk Public Library, the Town of Seekonk, its agents and representatives, from any and all suits, action, claims or demands of any character or nature arising out of or brought on account of any injuries or damages sustained by any person as a consequence or result of using the meeting room, its furnishings or its equipment.

As the individual or the accredited representative of the organization making the reservation, I agree to pay all fees and other associated costs for use of the meeting room as required by the Board of Library Trustees.

Person Making Request: (Please print your name)__________________________________________________________ Date: _______________

(Signature of Person Making the Request)__________________________________________

 Contact Person: __________________________________________

(If other than the representative signing above.)

Representative’s Address: ______________________________________________  Telephone: _________________  Fax:___________________
Email: ______________________________________________________________