Seekonk Public Library Meeting Room Request Form
Date(s) Requested:____________________________ Time Requested, from ____________ to ______________
Organization’s Name (if applicable): ________________________________________________________________
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 and agree to fully comply with the terms within. I further attest that I am the legally authorized and capable of entering into contracts on behalf of myself or my organization. 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 meeting room. As the individual or the authorizedrepresentative 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.
I further agree as a condition of my use or that of my organization not to claim or imply that the library endorses the information presented at this program. I further agree as a condition of my use or that of my organization not to claim or imply that the library has verified any of the information presented, claim or imply that the library supports the opinions and conclusions of the presenter, or claim or imply that the library endorses any recommendations made during the program. The library reserves the right to require a formal disclaimer to this affect, and I agree as a condition of my use or that of my organization to make or distribute such statements as required. I also agree not use the library’s logo or images of the Seekonk Public Library in any invitations or promotional materials associated with this program without the expressed permission of the Library Director.
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. I also agree as a condition of my use or that of my organization to provide liability coverage when it is deemed appropriate by the Board of Library Trustees.
(Your Title or Position if applicable)
(Name of Your Organization if applicable)
(Signature of Person Making the Request) (Date)
(Name of a Contact Person if other than the representative signing above.)
(Your or the Contact’s Address)
(Your or the Contact’s Telephone) (Your or the Contact’s Fax)
(Your or Contact’s the Email Address)
Last updated: June 2015