PERMIT FOR THE USE OF THE GRANGE HALL

This permit is for the use of the Grange Hall for a _______________________________

to be held on _____________, from ____ (a.m./p.m.) to _____ (a.m./p.m.)

with _____ people in attendance.

______________________________________

Name of applicant

______________________________________

Street Address

______________________________________

Town, State, Zip Code

______________________________________

(Area Code) Telephone Number

The applicant, upon signing this permit, agrees to accept financial responsibility for any damages occurring to the Grange Hall property during its use on ________________, will abide by the restrictions as listed on the back and understands and agrees to the following:

A.)  Alcohol is permitted on the premises under certain conditions and only with written approval of the Board of Selectmen as follows:

Permission denied/granted with the following conditions:

1) Receipt of insurance certificate:______________________
2) _______________________________________________
3) _______________________________________________

B.)  All bottles, cans, waste and trash must be cleaned up and removed from the Grange Hall by the recipient of this permit.  Certified by ____________________________

Grange Hall Trustee             Date

___________________________________________________

Signature of Applicant Date

_____________________________________________________________

Selectman                                                                                              Date

_____________________________________________________________

Selectman                                                                                              Date

_____________________________________________________________

Selectman                                                                                              Date

Permit fee: $________ received by _______________________

Date

*Refundable security deposit of $_______ is required, to be returned if facilities are left in the same condition as rented.                                    

Restrictions:

· No tacks, staples, masking/scotch tape may be used in the Grange Hall.  Blue painter’s tape is permitted.

· No decorations may be attached to the lighting fixtures (ceiling), nor may the globes or bulbs be removed.

· The piano may not be moved without permission from a Grange Hall Trustee.

· No signs may be attached on the interior or exterior of the building without permission from the Grange Hall Trustees.

Damages will be assessed and billed to the applicant of this permit if restrictions are violated.