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2. 1. APPLICANT:
4. First Name*
5. Last Name*
7. Phone Number:*
9. Email Address:*
11. 2. FACILITY: What facility are you requesting use of?
    -- Select One --Essex Police Community Room
13. 3. PURPOSE: What type of event are you holding?*
15. 4. OCCUPANCY: What will be the maximum occupancy of your event?*

    (There are only 28 parking spaces available. If you think your occupancy will exceed parking, please suggest carpooling or coordinate other parking options)

17. 5. DATE OF USE*
    5. DATE OF USE
18. TERM OF USE: List time slot*
    TERM OF USE: List time slot Start Time

    —

    TERM OF USE: List time slot End Time

    (Include setup and cleanup time in your requested time slots

20. 6. TERMS OF FACILITY USE. The User understands and agrees to all of the following terms of use:
    • The sale, possession, consumption, and use of tobacco, marijuana, and illegal drugs are forbidden in the Facility and on its grounds (parking lots, walkways, etc.).
    • Requestors to use the Essex Police community room acknowledge they have read, understand and fully accept the Emergency Operations Center exemption outlined under Priority of Use section of this policy.
    • Animals are not permitted inside the Facility with the exception of service animals.
    • No sign or temporary structure may be placed on the premises without obtaining advance written approval from the Town. Any signs or temporary structures placed on the premises by User shall be promptly removed by the User at the end of the Event.
    • The Facility, its appurtenances, and any equipment contained therein may not be injured, damaged, marred, or defaced in any way. Neither shall nails, hooks, tacks, or screws be driven into any wall or other part of the Facility.
    • User is responsible for cleaning the Facility immediately after the Event. All trash should be removed from the facility, and surfaces should be cleaned.
    • Use of the Facility shall not create any nuisance or disturb the quiet enjoyment of anyone using adjacent or common premises and facilities.
    • User is responsible for the cost of all repairs to the Facility required as a result of damage caused by User or User’s employees, agents, contractors, licensees, guests, or invitees.
    • Vehicles are not permitted anywhere other than in designated parking spaces outside the Facility. Note: Maximum use of 28 parking spaces.
    • For all Events involving minors (persons 17 years or under), there shall be at least 1 adult(s) over 18 years of age for every 8 minors for the duration of the Event.
    • The Town does not warrant or represent that the Facility is safe and suitable for Userʼs purposes. User expressly acknowledges for itself and for all persons who will be utilizing the premises and Facility in connection with Userʼs purposes that Town is providing the premises and Facility on an “as is” basis.
    • User is responsible for all actions of its participants and guests;
    • User that is in violation of the foregoing terms of use will be expected to immediately vacate the premises of Town.
    • The Town reserves the right to immediately terminate this Agreement and Userʼs use of the Facility in the event of any violation of the foregoing terms of use without liability to Town. In the event that Userʼs use of the premises and facilities involves participants who are minors (including the minor children of participants), then User shall be responsible for the safety of all such minors and shall place such minors under the constant supervision and control of a responsible adult. 
22. 7. VACATING FACILITY.

    At the expiration of the above stated date and time, or upon the earlier termination of this Agreement, User will promptly and peaceably vacate the Facility and remove its employees, agents, contractors, licensees, guests, and invitees and their property from the Facility and conduct the cleaning activities specified in Section 5 of this Agreement so that the Facility is in the same condition as at the inception of the Event.

24. 8. INJURIES TO PERSONS AND LOSS OR DAMAGE TO PROPERTY.

    The Town is not liable for any injury to persons or loss or damage to private property which occurs during the Event. User is financially responsible for any damage to or loss of Town property that occurs during the Event.

26. 9. IDEMNIFICATION AND HOLD-HARMLESS.

    User agrees to indemnify and hold the Town, its officers, agents, and employees, harmless from any loss or liability which may result from claims of injury to persons or property from any cause arising out of or during the use and occupancy of the Facility by User and User’s employees, agents, contractors, licensees, guests, and invitees. 

28. 10. RIGHT OF ENTRY AND TERMINATION.

    The Town, its officers, agents, and employees shall have the right to enter the Facility at all times during the Event to confirm User’s conformance to this Agreement. If the Town determines, in its sole judgment, that User has breached a term of this Agreement, the Town shall have the right to immediately terminate this Agreement prior to the expiration of its term without any refund to User. 

30. 11. CONFORMANCE WITH THE LAW.

    User agrees that User will abide by and conduct its affairs in accordance with the Town’s Facility Use Policy and all laws, rules, regulations, and ordinances, including those relating to alcohol consumption and noise. User shall not engage in or allow any illegal activity to occur at the Facility during the contracted time frame for its entry and use. 

32. 12. ENTIRE AGREEMENT.

    This Facility Use Agreement, together with any exhibits or addenda annexed hereto, is the sole and complete expression of the parties’ intent with respect to the subject matter hereof. This Agreement may be amended or modified only by a writing countersigned by authorized representatives of each party.

34. NAME OF ORGANIZATION*
36. ACCEPTANCE OF RULES AND HOLD-HARMLESS CLAUSE.*

    1. YES, I understand and agree.
    2. NO

    By choosing "YES, I understand and agree" and typing my name below, I confirm that I am acting on my own behalf and also acting on behalf of the named organization, being fully authorized to do so, hereby waive and release any and all claims against the Town of Essex, together with its various departments, employees, officers, elected officials, agents, and any and all other persons or entities acting on its behalf, from any and all actions of any nature whatsoever asserting any injury, accident, harm, loss, damage, or cost arising in connection with the use of any facilities pursuant to this Agreement, and further undertake to defend and indemnify all of the aforesaid parties against any and all such claims and forever hold them harmless from the same. I also certify that I have read this form and that all information stated herein, including any information on the facility use policy appended hereto, is true to the best of my knowledge, information, and belief.

38. TYPED NAME OF USER*

    Use of the facility is not approved until a duly authorized agent of the Town of Essex has confirmed the facility reservation. If you do not receive a response, please contact the person identified in the Facilities Use Policy. 

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42. Submit

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