Village Hall Upstairs Use Permit

Applicant's Name * Required
First Last
Address * Required
Street Address Address Line 2 City State ZIP Code
Phone * Required
Email * Required
Name of Organization And/Or Event * Required
Head of Organization * Required
Head of Organization Phone * Required
Person in Charge of Event
Person in Charge of Event Phone
Alternate Person in Charge of Event
Alternate Person in Charge of Event Phone
Requested Location * Required
Event Date(s) * Required
Time and Duration of Event * Required
Type of Event * Required
Purpose for this use * Required
Agreement * Required
I agree to the below
I agree to be responsible for the safe and orderly conduct of the group above and the associates thereof in attendance.

I further agree that I, myself, or the alternate adult in charge shall be present and actively supervise the group and its associates from the beginning of the activity until all such persons have left the building. If neither undersigned person can be present to supervise, it is my responsibility to cancel the above activity and notify the Village Clerk before the activity was to begin.

The applicant/organization is responsible for the cleanup of the room and other areas used for this event. The applicant agrees to pay all costs for said clean-up and will reimburse the Village of Greenwich for any and all additional custodial costs as well as other expenses incurred as a result of this activity.

The applicant/head of organization has read and understands the Conditions for Use of Village Facilities on reverse side of this form.
If the Village of Greenwich requires you to obtain insurance for this event, who will the insurance carrier be?
Name of Company
Agent's Name
Insurance Carrier Address
Street Address Address Line 2 City State ZIP Code
Insurance Carrier Phone
Applicant's Signature * Required
Date of Signature - must be mm/dd/yyyy format * Required
Date Format: MM slash DD slash YYYY
Alternate Person in Charge of Event Signature * Required
Date of Signature of Alternate Person in Charge of Event - must be mm/dd/yyyy format * Required
Date Format: MM slash DD slash YYYY
INDEMNITY AND HOLD HARMLESS AGREEMENT

To the fullest extent permitted by law, the Permit Holder shall indemnify and hold harmless the Village of Greenwich, its elected officials, officers, agents and employees from and against any and all claims, damages, losses, costs and expenses, including but not limited to reasonable attorneys fees, arising out of the use of the Premises and/or actions of the Permit Holder, its guests, employees, agents, contractors, suppliers, vendors, or anyone directly or indirectly employed by Permit Holder or anyone for whose acts Permit Holder may be liable.
Applicant's Signature * Required
Date of Signature - must be mm/dd/yyyy format * Required
Date Format: MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

INDEMNITY AND HOLD HARMLESS AGREEMENT

Village of Greenwich

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