APPLICATION FOR USE OF THE SHELBURNE TOWN HALL

RETURN COMPLETED FORM TO: Town Manager's Office, Attn: Judy
                                                       P.O. Box 88
                                                       Shelburne, VT 05482
                                                      Phone: 264-5031 Fax: 985-9550

OR SUBMIT FORM BY CLICKING AT THE BOTTOM OF THIS FORM

* EVENT:

* ORGANIZATION:

* Shelburne Resident/Business?

Yes

No

* ADDRESS:

* EMAIL ADDRESS:

* PHONE/DAY:

* PHONE/NIGHT:

* Date Requested:

* Start Time

* End Time

* EVENT:

Date Requested:

Start Time

End Time

EVENT:

* DO YOU NEED TABLES?

Yes

No

* HOW MANY?

* HOW WOULD YOU LIKE TABLES ARRANGED?

* DO YOU NEED CHAIRS?

Yes

No

* HOW MANY?

* HOW WOULD YOU LIKE CHAIRS ARRANGED?

SPECIAL REQUESTS:

PURPOSE OF EVENT:

* CERTIFICATE OF
INSURANCE REQUIRED?

Yes

No

* DEPOSIT
REQUIRED?

Yes

No

* FEE:

* APPROVED:

Individuals and groups granted permission to use the Town Hall are responsible for understanding and agreeing to abide by these rules. The rules have been established with the prudent care of the Town Hall and the needs and safety of users in mind.

PLEASE READ CAREFULLY AND CONSIDER THESE RULES, then sign at the bottom of this page and return the original to the Town Manager's office at least 3 days prior to your event, retaining a copy for your reference. If you have questions about any of the rules, please be sure to ask in advance.

1. ) The designated "responsible party" is to obtain the front door (Route 7) key from Police Dispatch upon arrival.

The front door and the door between the Town Hall and the Library lobby landing are to be locked and the key returned to Dispatch when the event is concluded. The same key works for both doors. If you will be using the Town Hall for more than one day, the key is to be returned to Dispatch at the end of each day. You will be asked to leave a driver's license or other form of ID at Dispatch until the key is returned.

2.) The front door of the Town Hall is to be used as much as possible by participants, limiting use of the entrance from the Pierson Library to handicap access, access to the restroom or other instances in which the front door cannot be used.

3.) Permission to use the Town Hall is valid only for the date(s) and time(s) indicated. No items are to be stored in the building before or after the event except with express permission.

4.) Outdoor advertising, signs, banners, etc. are not permitted without express permission of the Town Manager.

5.) No tacks, pins, tape or other adhesive materials are to be used on any surface in the Town Hall.

6.) Access to the balcony is prohibited for safety reasons.

7.) Smoking is prohibited in the building, and the use of alcoholic beverages is prohibited on all Town property.

8.) Food is to be served by special permission only. Use of electrical appliances, candles, propane, or any such substance is not permitted.

9.) Event participants must be careful not to park in a manner that would interfere with emergency fire vehicles, for both access to the front doors of the Fire Station and for circulation around the perimeter of the Fire Station. Be aware of restricted parking spaces. Police Department will issue tickets.

10.) All trash is to be removed by the users on the event day.

11.) At the conclusion of the event the premises are to be left broom clean and in the same condition as in prior to use. Lights are to be turned off, and heat is to be turned down or air conditioning temp turned up.

* I HAVE READ THE ABOVE AND AGREE TO ABIDE BY THE RULES AS STATED, AND I WILL MAKE ALL MEMBERS OF THE GROUP AWARE OF THEM.

Clicking Yes will be equivalent to your signature on this form.

Yes

No

* Responsible Party

* Group Name

* Date

* Indicates Response Required