4180 – 105TH AVENUE


Applications must be submitted to the Town Clerk at least 14 days before the Event

along with the $75.00 Rental Fee, plus $150.00 damage deposit (separate check).

Date of the Event:_______________________Type of Event:_____________________

Applicant Information:

Name: ________________________________Date of Application:________________

Address:_______________________________Home Phone:______________________

_______________________________________Work Phone:_____________________

Rental Hours: Start time:____________End Time:_____________

Alcohol: Will any alcohol be brought to or consumed at the event? _____Yes _____No

IMPORTANT: Alcohol may not be sold or otherwise exchanged for compensation in any way in connection 

with the use of the Hall. If alcohol will be present, the Town may require a licensed law enforcement officer to

provide security for the event. The Town will require proof of insurance if alcohol is to be served.

Insurance: Applicant may be required to provide proof of liability insurance before the event in an amount determined by the Town..

Residency: Is the applicant a resident of the Town? _____Yes _____No

Rental Fees and Damage Deposit: A non-refundable application fee must be paid at the time of submitting the application. All additional fees and a damage deposit, must be paid to the Town at least 14 days before the event or this application is voided. The applicable fees are those as set by the Town in its Township Hall Rental Policy.

Applicant understands and agrees that if its application is approved, applicant is fully responsible for the event and is subject to the terms and conditions of the Township Hall Rental Policy.

Applicant’s Signature:_________________________________Date:_______________

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