Laserfiche WebLink
Application for--Use or Rental <br />of Community Room Building <br />Date of Application <br />HAYFIELD VILLAGE <br />6621 Wilson Mills Road - Phone 461-2210 <br />Applicant Phone Number <br />(M.V. resident, 21 years or older) <br />Organization Official Position <br />Address Signature <br />Individual responsible for facility, representing organization or group: <br />Name <br />Address <br />Facility (be specific) <br />Date Desired <br />Event and Purpose <br />Room Arrangement Desired (attach sketch) <br />Organization <br />Phone Number <br />Use of kitchen desired: ( )YES ( )NO <br />Hours <br />Maximum Number of People Attending <br />In accepting this permit, the user of any facility assumes full liability f.or damage to <br />persons or property, either private ar public, resulting through its issuance. <br />The user of any facility assumes the responsibility of general clean-up and proper disposal <br />of waste materials. <br />Failure to abide by rules and regulations of facility will result in the revocation of all <br />further privileges. <br />Cancellation of special events must be made 72 hours prior to event, with a $25.00 penalty <br />to be charged. <br />Police and parking services requires ( )YES ( )N0. If required, applicant will be <br />responsible for arranging and paying for such services as .stated in rules. <br />Permission to us.e the above stated facility has been made possible by the Village_of <br />Mayfield. Therefore, any usage is subject to all rules and regulations of Mayfield <br />Village. <br />Approved by: <br />MAYOR <br />(Final decision of issuance of permit rests with the above signed.) <br />dOT TO BE FILLED IN BY APPLICANT: <br />'Request Approved <br />Rental Fee $ <br />Damage Deposit $ <br />Request Denied <br />Receipt Number <br />Receipt Number <br />Date <br />Date <br />Please sign all three copies and return to Mayfield Village• One copy will be returned <br />to applicant. <br />