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2. Name of Organization*
3. Type of Organization*
5. Person Responsible*
6. Phone Number*
7. Email Address*
9. Address*
11. City*
12. State
13. Zip Code
15. Date and Time of Reservation (Please indicate below start time and end time)
17. Date*
    Date Start Date

    Date Start Time

    —

    Date End Date

    Date End Time
19. RULES AND REGULATIONS FOR THE USE OF THE NORTHLAKE MUNICIPAL COMPLEX

21. 1. The building will be available for regular use by reservation from 9:00 am until 10:00 pm (Mon-Friday).

    2. Official Town meetings and functions will take precedence over any other use of the facility.

    3. The following fees and deposits shall apply based on function classification:                                

    A. Senior Citizens Function         FEE:    $0                                                    DEPOSIT:   $0

    B. Northlake Residents                FEE:   $0                                                     DEPOSIT:   $75.00

    B. Non-residents                           FEE:   $75.00                                              DEPOSIT:   $150.00

    4. Reservations shall be made in person by an adult over 21 yrs. of age, at least 48 hours in advance at Town Hall during regular business hours. The deposit will be paid at the time of reservation.

    5. Deposit shall be returned upon inspection of premises. The deposit shall be retained in lieu of damage to property or if the property is not left clean and orderly with all trash removed.

    6. All teenage functions shall be chaperoned by one (1) adult over 25 years of age per every 10 teenagers.

    7. No religious services, political party meetings, or election campaign events of any kind are to be held at the facility.

    8. The Town of Northlake is not liable for lost or damaged articles belonging to persons or groups.

    9. The assembly room will be limited to 50 people.

    10. NO ALCOHOLIC BEVERAGES, TOBACCO PRODUCTS, GUNS, KNIVES, and other weapons are allowed in the Municipal Complex Chamber Room.

    11. No attachments are to be made to any wall or other part of the building without the express permission of the Town Council.

    12. If the kitchen is used, please see that the microwave, sink, and counter tops are left clean.

    13. Put all disposable articles in plastic bags and place in a dumpster outside of the building.

    14. All tables and chairs must be cleaned and stored in proper places after use.

    15. All floors and restrooms must be left clean.

    16. Any and all exceptions or additions to these rules and regulations must be granted by the Town Council prior to reservation.

    STATEMENT OF AGREEMENT. By this agreement, the above-named organization or individual agrees to be responsible for the return of the Northlake Municipal Complex Chamber Room in as good or better condition than was received and to pay any and all costs of replacements, repair, improvement occasioned by Joss or damage during the use thereof by said above-named individual or organization. The above-named individual or organization further agrees to comply with all the rules and regulations applicable to the Northlake Municipal Complex Chamber Room, including any and all Federal, State, and local laws, rules, ordinances, and regulations.

23. Acceptance of Agreement & Signature

    I acknowledge and accept the agreement as outlined above and understand my reservation will NOT be scheduled until the required deposit has been submitted to the Town Secretary's Office,

    I further acknowledge that typing my name below will constitute as my signature and will have the same legal impact as signing a printed version of this application. 

25. Date*
    Date
26. Responsible Party Signature (TYPE YOUR NAME)*
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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

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