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City of Northampton, Massachusetts
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Senior Center Building Use Application

  1. Northampton Senior Center Building Use Application
    Please return this completed application to: or Northampton Senior Center, Building Use Application, 67 Conz St., Northampton, MA 01060
  2. This individual should be the designated representative
  3. Requests for catering will be considered on a case by case basis. Please inquire about menu/pricing for public events.
    (NOTE: Outside snacks are only permitted for private groups.)
  4. Desired rental dates and times & estimated number of attendees:
    Please list all desired dates and times, # of people and dates that catering is requested. Attached additional sheets if needed.

    (NOTE: All rentals are charged from the time access is needed to the building to when you vacate the building, NOT just the duration of the event. Please include time for set up and breakdown in the request to ensure adequate staff is available to meet your time frame.)
  5. Room Requested?*
    NOTE: The lobby is not available for rental and may be cordoned off during your event.
  6. # of round tables for 8
  7. # of chairs with arm rests
  8. # of 6 ft. rectangular tables
  9. # of chairs without arm rests
  10. (Podium, white board, extra large garbage cans, etc.)
  11. BUILDING USE AGREEMENT: Please read the following statement, by signing below you state that you understand and agree.
    I understand that I, or the organization requesting use of the Northampton Senior Center building, am responsible for obtaining any and all required City permits. I understand that the Northampton Senior Center is not responsible for any lost/stolen belongings, or any other adverse outcomes of the rental event.

    I understand and agree, in consideration for being granted use of the property and facilities of the City of Northampton’s Senior Center, that I assume any and all risks with respect to such access of Northampton, its representatives, agents, servants and employees from liability for any injuries sustained or damage incurred in the course of such access and use resulting from any casualty whatsoever which may be sustained.
  12. Leave This Blank:

  13. This field is not part of the form submission.