ROOM USE APPLICATION

Reservation, Insurance, and Liability Form

Cheboygan Area Public Library, Cheboygan, MI

Library Center for Community Programs

Please read the LCCP Use Policy before completing this form.

Date of Application: _________________________________

Name of Group: ____________________________________

Contact Person: ________________________________ Phone: _______________________

Name of person(s) supervising event (if different than above): __________________________

Address: ____________________________________________________________________

Program Information:

Date(s) of the event: __________________________________ Hours: __________________

Type of Activity: ______________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Expected Attendance: Adults ___________ Children _____________

We have read and agree to abide by the Cheboygan Area Public Library's policies and procedures governing the use of the Library's facilities. We also agree to defend and hold harmless and idemnify the Library and any of its employees or agents from any claims, suits or other actions arising from, caused by, or which are the result of any alleged act or omission of any organization, corporation, guest, invitee, licensee, visitor or other person present on the Library premises for the purpose of participating in, organizing, assisting, enjoying, supervising or in any other way furthering the activity to be held (as described above) on the date(s) listed above. The undersigned is authorized to execute this agreement on behalf of this organization.

You will be contacted by library staff to confirm your application. If you have questions please contact Mel Eno at 231-627-2381, eno.melanie@cheboyganlibrary.org. Submit form via fax: 231-627-9172.

Signature of Applicant: ________________________________________________

Date: _______________________________

Approved: ________________________________________________ Date: _________________
Board approved 12/8/2005 Revised 11/9/2008