Meeting Room Request – Wethersfield Library

Please fill out as completely as possible.

Name(Required)

First Last

Group or Organization(Required)

Phone(Required)

Email(Required)

Library Card Number(Required)

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Date Requested (limit of 3 months in advance)(Required)

Starting Time(Required)

Ending Time(Required)

Estimated Attendance(Required)

Please enter a number from 5 to 60.

Brief Description of Room Usage(Required)

Is this a Non-Profit?(Required)

If yes, what is your non-profit number?

Will you need any of the following?

Chairs

Head Table

Podium

Tables (seat 2-3 people)

Projector

Projection Screen

Whiteboard

Microphone

Extension Cord

Room Setup

Additional Setup Notes (number of chairs and/or tables, etc)

Check all those that apply:(Required)

I do not need to use the Library's audio/visual equipment.

I have requested the use of the audio/visual equipment, and understand that if approved, I will need to meet with Library staff to ensure compatibility of my equipment.

I plan to show a film, stream online content, have a music performance where the performer will play music other than their own original material, or use copyrighted media. I have obtained Public Performance Rights to use this media. I understand that a meeting room in a public place does not constitue "individual viewing" or fair use.

Please check both boxes to acknowledge the following:(Required)

I am at least 18 years old and acknowledge that I need to be present for the duration of the scheduled use of the Meeting Room.

Untitled(Required)

I have read the entirety of the Library’s Meeting Room Policy and understand my responsibilities as part of the agreement to use a Meeting Room.

Understanding and Agreement

To the extent provided by law, the individuals hereby understand and agree, if this application is granted, the undersigned will assume all and exclusive responsibility for the preservation of order and the sole and exclusive liability for all injury to persons, and any damage to, or loss of property that may result from this use; and for the due observance of all Library Policies. The individual and/or organization agrees to indemnify the Library and the Town of Wethersfield and hold the same harmless against all claims, demands, damages, costs and expenses including reasonable attorneys’ fees for the defense of such claims, arising out of the individual and/or organization’s use of the meeting rooms.

This application and agreement is not complete and will not be considered until signed by requester and dated below.

Signature(Required)

By entering your name below, you are signing this application electronically.

Today's Date(Required)

Submission of this request form is not a guarantee of reservation. The Library will strive to respond within 72 business hours.

Wethersfield Library

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Library Hours

Meeting Room Use Application and Agreement Form

Please fill out as completely as possible.

Understanding and Agreement