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DUDLEY GRANGE #163

AGREEMENT FOR USE


OF BUILDING AND GROUNDS
(Non-members RENTAL Form)

In consideration of a rental fee of ($85.00 Dudley Grange #163 agrees to allow the
undersigned person the use of all facilities on the first floor of the Grange Hall to include the
main room, kitchen, and bathrooms (outside grounds may be used as well) for the following
date and time period:

DATE:_______________________

FROM: _______________TO: ______________

1. FIRE PROHIBITION NO SMOKING, OPEN FLAMES, OR STERNO.

2. ALCOHOL PROHIBITION NO ALCOHOL ON THE PREMISES.

3. ANIMAL PROHIBITION - NO PETS INSIDE BUILDINGS (PLEASE PICK UP PET WASTE ON


GRANGE GROUNDS)

4. The undersigned agrees to leave the Grange in as clean condition as it was before use.
("The Grange ask that you please secure all trash in trash container located on the first of the
Grange Building.")

5. The user shall hold the Grange harmless for any personal injury or property damage,
which may occur as a result of the use of the Grange.

6. The undersigned individual is liable for any responsibilities arising from this contract.

Users Signature: ________________________________ Date: ________________________

Users Name: ___________________________________ Phone: _______________________

Address: _____________________________________________________________________
Grange Agent Signature: ___________________________ Date: _______________________

Make checks payable to: Dudley Grange #163. Return contract and check to:
Dudley Grange, P.O. Box 1514, Dudley, MA 01571

Dudley Grange #163


Rental Key

Dudley Grange Door key is located


in a key safe mounted on the right
side of door frame of the center door.

Pass code for the key safe is:

Enter code as follows:

1. Zero out numbers to set line.

2. Then enter code to set line.

3. Push down lever button on the lock


and it should open.

4. Please make sure to return key and


clear code after use.
5. Please make sure door is locked and
shut upon leaving.

Please call Alex Rodinov @ (774-922-2930) or Ken Gillon @ (508-341-6196) if


you are unable to open the key safe.