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APPLICATION FOR USE OF: SHELBURNE TOWN HALL

Please complete this form, and upon submit, a PDF will be generated and sent to the appropriate dept. (or you can also print the completed form, if desired).

For Departmental Use Only
  Copy to Maintenance
  Outstanding
  Added to Calendars

APPLICATION FOR USE OF:

SHELBURNE TOWN HALL
5376 Shelburne Rd.

TOWN OF SHELBURNE

RETURN COMPLETED FORM TO:
Town Manager’s Office, Attn: Judy Lance
P.O. Box 88, Shelburne, VT 05482-0088
FAX TO: 985-9550
EVENT:
ORGANIZATION:
CONTACT PERSON:
Shelburne Resident? Yes No EMAIL ADDRESS:
ADDRESS:
PHONE/DAY: PHONE/NIGHT:
DAY/DATE REQUESTED: START/END TIMES:
DAY/DATE REQUESTED: START/END TIMES:
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:

QUESTIONS? Call Judy at 264-5031.
email: jlance@shelburnevt.org

For Departmental Use Only
CERTIFICATE OF INSURANCE REQUIRED:
  Yes
  No
APPROVED  
FEE  
DEPOSIT REQUIRED:
  Yes
  No

Shelburne Town Hall Rules and Regulations for Use

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, and restroom to be checked and left tidy.
  • 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
* Signature of Responsible Party
* Group Name
* Date

Town of Shelburne - Waiver for use of Shelburne Town Hall

EVENT:
ORGANIZATION:
RESPONSIBLE PERSON:

Release made on,   by  

In consideration of permission granted to us by the Town of Shelburne to use the Town Hall on,
we hereby and forever discharge and release the Town of Shelburne, its agents, employees and officers, from all actions, claims, demands, judgments and damages which we, or any of the participants in our functions, may have, or claim to have, or acquire in the future, for all personal injuries, or damage to property arising out of our organization’s /group’s use of the above described facilities. We acknowledge that we have total responsibility for the group and safety of all its participants. In addition, we acknowledge that the Town of Shelburne has no responsibility for the condition of the facility and that an authorized agent from our organization/group shall always inspect the premises and access thereto prior to use, to ascertain that the premises are in safe condition.

IN WITNESS WHEREOF, the undersigned, being a duly authorized representative of the above named organization/group has executed this release on the day and year first above written.

Clicking this button will be equivalent to your signature on this form. APPROVAL & SIGNATURE

 
Signature


Print full name

QUESTIONS? Call Judy at 264-5031.
email: jlance@shelburnevt.org

* Indicates Response Required







P.O. Box 88
5420 Shelburne Road
Shelburne, VT 05482
phone: 802-985-5110
fax: 802-985-9550
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