Damage, Indemnification, and Applicant-Hold-Harmless Agreement form

The undersigned agrees to assume responsibility for the preservation of order at the Chatfield Public Library and liability for any damage thereto and for the observance of all policies, rules and regulations of the Chatfield Public Library and further release the City of Chatfield, the Chatfield Public Library, and their respective officials, employees, and agents from any liability of any kind whatsoever arising out of participation, organization and/or sponsoring the use of the Chatfield Public Library Meeting Room. The undersigned further agrees to indemnify and hold harmless all of the aforementioned parties from and against any and all actions, causes of action, losses, damages, liabilities, and claims, and all fees, costs and expenses of any kind related thereto (including without limitations, reasonable attorney’s fees), arising out of or resulting from claims based upon or related to participation, organization and/or sponsorship of use of the Chatfield Public Library Meeting Room.

The undersigned is at least 21 years of age and intends to be bound by this agreement.

I HAVE RECEIVED AND READ THE CHATFIELD PUBLIC LIBRARY’S MEETING ROOM POLICY AND UNDERSTAND THAT I AM PERSONALLY RESPONSIBLE FOR MY GROUP’S ADHERENCE TO SAME.

NAME_______________________________________

PHONE (day)_________________________________

PHONE (evening)______________________________

ADDRESS______________________________________________________

______________________________________________________________

Signature___________________________________________

Date__________________________

Group I represent ______________________________________________

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