Application for the Use of the Milford Youth Center

24 Pearl Street, Milford, MA 01757

Phone (508)473-1756

Fax (508)381-0759

milfordyouthcenter@comcast.net

**MUST BE 21+ TO RENT OUT FACILITY**

IMPORTANT: Refer to Regulations and Fee Schedule before completing application. Submit application at least 21 days prior to requested dates(s) – dates cannot be outside calendar year

Return application (by appointent only) to the Milford Youth Center, 24 Pearl Street, Milford, MA 01757.

Your Name *

Organization Name

Date *

Email Address *

Contact Phone *

Address *

I/We request use of: *

Dates Requested *

From & To Hours (AM or PM) *

Day of Week *

If there is any additional information for dates requested, please add here.

If a License is required for rental, please acquire at: Town Hall, Town Administrator & Selectman's Office (52 Main Street)

Are you a non-profit organization? *

Yes

No

Are you collecting a fee or admission charge? *

Yes

No

If yes, what is the fee? *

Expected Attendance (If the attendance is above 100 people then insurance is required) *

Milford Youth Center Equipment to be Used

Chairs ($1/each)

Tables ($5/each)

Jumpy ($100/event)

Describe any unique or unusual special effects planned for your event

Please describe in detail any other request not covered above

Will you be providing insurance information that will be covering your rental? (If no, all participants must complete liability forms prior to rental) *

Yes

No

There must be at-least one adult supervisor (21+) overseeing rental/program. An adult supervisor MUST be present at all times. If the rental is in more than one location throughout the facility, there must be an adult supervisor (21+) with each group. This includes after rental and until the last participant is picked up. List of Rental Supervisors who are at least 21 years of age who can be responsible for the rental in absence of the renter: *

I understand that my/my child(ren)’s name and photo may be used in photographs, videos, literature, web pages, and news releases in local papers and other media outlets. I, the aforementioned Participant or Parent/Guardian, give permission for my or my son/daughter(s) to be photographed and named for MYC rental for the Milord Youth Center. *

clear

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