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COUNTY OF MERCER DEPARTMENT OF HUMAN SERVICES
MERCER COUNTY LIBRARY SYSTEMCOMMUNITY ROOM REGISTRATION FORM 

AGENCY :(State, County..)_____________DEPARTMENT:________________________

NAME OF GROUP:_________________________________________________________

DATE & TIME OF RESERVATION:___________________________________________

CONTACT PERSON:________________________________________________________

ADDRESS:_________________________________________________________________

PHONE:___________________________________________________________________

PURPOSE OF MEETING:____________________________________________________

NUMBER OF PERSONS EXPECTED TO ATTEND:______________________________

DO YOU PLAN TO BE HERE AFTER 9:00 PM?__________________________________

ASSIGNED TO ROOM:______________________________________________________

STAFF PERSON TAKING REQUEST:______________________DATE:______________

I hereby:

1. Assume full responsibility for any loss or damage to property of the Library, which 
may occur during the group’s use of the Library Community Room and absolve the 
Library of any responsibility for any loss or damage to property of the group or individual 
or injury to the group or individual while the group is meeting in the Library.

2. Although, light refreshment will be allowed in the outside community rooms, there 
will be no food or drink allowed in the inside community rooms. 
Groups will assume responsibility for room set up and clean up.

3. The groups must vacate the inside community rooms by 8:30 pm, Monday through 
Thursday, 4:30 pm Friday, 4:30 pm Saturday and 4:30 pm on Sunday. 

4. Understand that any group who violates any of the Library Community Room policies 
will not be permitted to reserve a community room again.

5. Agree to limit the size of the group to the capacity of the meeting room, 
which is_________________

6. Certify that I have received, read and will abide by the rules relating to the use of the 
community rooms.

7. Certify that the organization I represent is not for profit and not holding a religious service.

8. Understand that any advertisement must be reviewed by the Library Branch Manager or 
their designee for approval. Such advertisements will include the statement; “meeting of 
an organization at any of the facilities of the Mercer County Library System in no way 
implies endorsement of its programs.”

SIGNED:__________________________________________DATE:______________________