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2. Name of Organization*
4. Purpose or Goals of Organization*
6. Name of Contact Person / Primary Representative*
8. Email*
9. Phone Number*
11. Address*
13. City*
14. State*
15. Zip Code*
17. Name of Additional Representative*
19. Email*
20. Phone Number*
22. Address*
24. City*
25. State*
26. Zip Code*
28. The applicant hereby agrees to hold the City of Daly City, its City Council, Library Board of Trustees, the individual members thereof, and all officers, agents, and employees free and harmless from any loss, damage, liability, and cost of defense that may arise in any way from applicant’s use or occupancy of Library facilities.
30. I hereby certify that I have received, read, and understood the Policy for Public Use of Community Meeting Room, that the group I represent is a qualified group as described in the Policy, and that we will adhere to the rules for use of the meeting room. Further, I realize that the Daly City Public Library reserves the right to deny any application or to revoke permission previously granted. It is my responsibility to notify the Library of any cancellations on my part.
32. I, the undersigned, hereby certify that I will be personally responsible on behalf of the organization for any damages sustained by the Library’s buildings, furnishings, or equipment through the occupancy or use of said facilities by the applicant for this and all subsequent meetings.
34. Electronic Signature*

    1. Check to sign application
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36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

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