Name of Renter/Organization _______________________________________________________


Address ___________________________________________________________________________


City____________________________ State______________ Zip Code _______________________


Telephone(s) _______________________________________________________________________


Date of Event:   (mm/dd/yyyy)     ______________________________


Type of Event:      ___________________________________________________________________


Requested Time:  ___________________________________________________________________


*Any Continuous 6 hour period between 8 a.m. & 11 p.m.  - $75.00 + $50.00 Deposit (2 separate checks)

*Any additional hours - $10.00 per hour.

*All requests are subject to availability.


PLEASE keep a copy of the Rules and Regulations.


All fees must be paid Goshen Township before your reservation can be confirmed. 

Cancellation and return of fees is permitted with notification received in writing (7)

days prior to the event.  Late cancellations will result in forfeiture of your rental fee. 


As Registrant, you agree to be personally responsible for the cost of repairs and/or

cleaning necessitated by significant damage to the Community Building.  By your

signature you acknowledge that you have received a copy of the Rules and

Regulations and will adhere to them.  You will also be obligated to pay any increase

in deposit or rental fees if deemed necessary.


Property damaged caused by decoration, food, or insufficient cleaning of the premises

may result in the forfeiture of the security deposit and an additional charge for extra

clean-up services.



_______________________________________                              ________________________________

SIGNATURE OF APPLICANT                                                             DATE



AMOUNT OF PAYMENT____________________ CHECK#1________   CHECK#2________   CASH   $_________