Form Center

2. Name*
4. Address
6. City
7. State
8. Zip Code
10. Phone Number
11. Fax Number
13. Email Address*
15. Organization that you represent (if applicable)
17. Organization Purpose
19. Event purpose and description*
    Let us know what you plan to do at your event and what the goal of the event is.
21. Which space do you want to rent?*

    1. Gym -- capacity is 212 with tables and chairs and 450 without tables
    2. Room 16 -- capacity is 42 with tables and chairs and 80 without tables
    3. Room 13 -- capacity is 36 with tables and chairs and 68 without tables
    4. Cafe-- capacity is 130 with tables and chairs and 270 without tables

    Fee schedule: Classroom $50 Cafeteria $75 Gymnasium $100 Cafeteria with Kitchen (only with permission of Senior Center Director) $175 NOTE: There will also be a required refundable $100 deposit for damage and/or extra cleaning.
23. start date and time*
    start date and time

    start date and time
24. end date and time*
    end date and time

    end date and time
26. Will you have decorations?*
    -- Select One --YesNo
28. If yes, let us know how you plan to decorate.
30. Will you serve food or beverages?*
    -- Select One --YesNo
32. If yes, specify what type.
    If food is for sale the vendor will need a vending permit from the Woodbridge Police Department and will need to provide the Town with a certificate of insurance. If food is provided, under certain instances a Quinnipiack Valley Health Department permit may be required.
34. Room Set-up
    Describe how you would like the room set-up.
36. I have read the regulations and procedures and agree to comply.*

    1. Yes
37. Read the regulations and procedures here
    /DocumentCenter/View/2242/Center-Building-Room-Rental-Form-
39. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
41. Electronic Signature
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field