Form Center

2. City of Norton
   4060 Columbia Woods Drive
   Norton, OH 44203
   Phone: 330-825-7815
3. Shirley L. McGuire Community Center Rental Application
5. Renter Name or Organization
7. Address
9. Date of Activity
   Date of Activity

   Date of Activity
10. Time to Enter & Time to Depart
    Time to Enter & Time to Depart Start Time

    —

    Time to Enter & Time to Depart End Time
12. Room Reserved*
    -- Select One --Oak Room (Ballroom)Maple Room (Small Room)Dog Wood Room (Seniors Room)Buckeye Room (Board Room)
14. Applicant's Responsibilities Agreements
    - Maintenance - I certify that the facility will be left in as good a condition as it was found. I understand that disfigurement or removal of any city property is not allowed. It is my responsibility to reimburse the city for any costs incurred in returning the facility to its original condition. All rules, a copy of which is attached, will be observed.
    - Alcoholic Beverages – If you intend to serve alcoholic beverages, you are required to arrange with the Norton Police Department for an off-duty Police Officer to be on the premises. Inquiries to arrange for an officer must be forwarded to the Police Department (330-706-0084) not less than two (2) weeks before the scheduled function.
    - Insurance / Liability - I certify that I, or my renting organization, has liability insurance that will be in force on the date scheduled for use of the Community Center; and in consideration of permission granted by the City of Norton to use the center, hereby releases and agrees to indemnify and save harmless the City of Norton from any and all claims for injuries to persons or property arising from the use by such individuals or organization and guests on the date of use set forth above.
16. Daytime Phone Number
17. Signature of Applicant
21. Rental Fee Amounts
23. Resident (requires proof)
    Oak Room (Ballroom)
    Security Deposit: $200
    $45 per hour
    $225 more than four hours
    
    Maple Room (Small room)
    Security Deposit: $125
    $30 per hour
    $125 more than four hours
    
    DogWood Room (Seniors room)
    Security Deposit: $50
    $35 per hour
    
    Buckeye Room (Board room)
    Security Deposit: $50
    $25 per hour
    
24. Non-Resident
    Oak Room (Ballroom)
    Security Deposit: $200
    $75 per hour
    $350 more than four hours
    
    Maple Room (Small room)
    Security Deposit: $125
    $45 per hour
    $200 more than four hours
    
    DogWood Room (Seniors room)
    Security Deposit: $50
    $45 per hour
    
    Buckeye Room (Board room)
    Security Deposit: $50
    $35 per hour
    
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28. 1. Receive an email copy of this form.
29. Email address

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