Community Room Application

The Village of Round Lake provides space for Non-profit community groups to meet at the Police/ Public Works Facility (“Community Room”) located at 741 W. Townline Road, Round Lake, IL 60073. Facilities are available by reservation only and reservations will be granted on a first-come, first-served basis upon application. Applications will not be accepted more than 30 days prior to the event.

Application Submittal

Submit completed application along with the following:

A photo copy of Responsible Party’s state issued ID;
A certificate of insurance, including commercial general liability with coverage limits of not less than $1,000,000 per occurrence and $1,000,000 aggregate; and
Review the Community Room Rules and Information.

Contact

Please contact the Police Department with any questions.
Phone: (847)546-8112
Email

Group/ Organization

Name *

Phone Number *

Address *

City *

State *

Zip Code *

Email Address *

Responsible Party

Full Name *

Phone *

Address *

City *

State *

Zip Code *

Relationship to Group/ Organization *

Email Address *

Room Usage Details

Date(s) Requested *

Time(s) Requested *

Purpose of Room Use *

Estimated Attendance *

Equipment Needed

None
Projector
Microphone

WAIVER AND AGREEMENT TO INDEMNIFY I, the responsible party and the organization (applicant) for and in return for sufficient, good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, does hereby waive, release and forever discharge the Village of Round Lake, their agents, servants, employees, successors and assigns, and their respective heirs, personal representatives, affiliates, successors and assigns, and any and all persons, firms or corporations liable or who might be claimed to be liable, whether or not named, none of whom admit any liability to the undersigned, but all expressly denying liability, from any and all actions, causes of actions, lawsuits, claims and demands which the Undersigned now has or may hereafter have, arising out of or in any way relating to any and all injuries and damages of any and every kind, to both person and property, and also any and all injuries and damages that may develop in the future, as a result of or in any way relating to the application. The undersigned further agrees to indemnify the Village of Round Lake, its officers, agents, servants, and employees from any and all lawsuits, claims, demands, liabilities and expenses, including costs and attorney’s fees, for on account of any injury to person or property which may arise or may alleged to have arisen out or in connection with the application. I (We) have fully read and considered all of the terms and statements contained in this release before execution. I, the undersigned “Responsible Party” hereby state that I have been designated and given authority as agent to act on behalf of the above group/organization [applicant]. I hereby state that the information provided in this application is true and correct. I have received and read the Community Room Use Rules and Information and I affirm that the group/organization will abide by all rules and that I and the group/organization shall indemnify and hold harmless the Village of Round Lake from any and all loss, damage, cost or expense incurred as a result of the group/organization’s use of the room. I will be responsible for obtaining and returning all room keys and for insuring that room is returned in the condition it is received.

Responsible Party (Print Name) *

Date *