Springfield Public Library - Request Public Meeting Space

Application to use Public Meeting Space

ASSUMPTION OF LIABILITY STATEMENT

In consideration of the use of the Library Room and associated equipment, undersigned organization
agrees that:

a. It will pay for all damage to any property of the Library and/or the Township of Springfield resulting
directly or indirectly from the conduct of any member, officer, employee or agent of the organization,
or any of its invitees; and

b. It will hold harmless and indemnify the Library and the Township of Springfield and their boards,
employees and agents from and against any and all liability which may be imposed upon them for any injury to persons or property caused by the organization or any person in connection with a meeting.

Please fill out the form below to request Public Meeting Space

I have read the assumption of Liability Statement

Yes

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Full Name(*)

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Title

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Signature Date

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E-mail(*)

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Organization Name

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Room to be used

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Date and Time

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Room Application Form

Please complete all of the information below for the room Application.

Application Date

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Organization Name

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Organization Daytime Phone

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Authorized Representative Name

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Authorized Representative Phone

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Person Responsible at Time of Event Name

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Person Responsible at Time of Event Cell Phone

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Is the organization a non-profit?

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Organization Address - Springfield NJ only

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Organization Address Line 2

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Type of Function

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Start Date / Time 1

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Room End Date / Time 1

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Alternate Start Date / Time

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Alternate End Date / Time

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Additional Information

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Room Setup

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