Multi-Purpose Room Agreement

I have read and understand the room policies. I am responsible for ensuring compliance with the policies for the group for whom I am scheduling use of the room, for picking up the key during regular business hours (if needed), and for providing a head count for library statistics.

• Please print the name, address, and telephone number of your organization:
  __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________
• Name of Responsible Person:
  __________________________________________________________________________________________________________
• Signature of responsible person:
  __________________________________________________________________________________________________________
• Telephone number where you can be reached: ________________________________



• Library Staff Member taking the request: _____________________________________
• Date: ____________________
• Date Deposit Paid (If required):___________________________
• Date Deposit Refunded (If required): ______________________
• Approved By Library Director: ____________________________
• Date: ____________________