Community Room Rental Application GuidelinesThis form must be completely in its entirety and must be submitted for approval. A signed copy authorizing the use of the Community Room will be returned to the requesting party. Fees and the application must be on file five (5) business days prior to the event. “Resident” is defined as a person, group, or company having a Village of Mukwonago address.EligibilityMeeting rooms are available for use by: Village of Mukwonago sponsored activities. Civic groups which are Village of Mukwonago oriented and whose efforts are directed to the civic welfare of the community. Non-profit groups. Non-profit groups are those designated by the State of Wisconsin as having a tax-exempt status. Profits groups who pay the rental fee. Residents and non-residents for private events. Village of Mukwonago municipal employees may meet and use the room for employee related purposes. Village of Mukwonago municipal employees are subject to the same guidelines as the general public for the use of the room. Use of rooms for the purpose of individual or joint solicitations for funds, sales of merchandise, seeking of gifts or requests, etc. for the purpose of profit will be assessed the rental fee. The following groups are not subject to rental rates: Village of Mukwonago sponsored activities. Civic groups which are Village of Mukwonago oriented and whose efforts are directed to the civic welfare of the community. Non-profit groups. Non-profit groups are those designated by the U.S. Internal Revenue Service or State of Wisconsin as having a tax-exempt status – no charge, unless the event is a fundraiser.Deposit RequirementsThe applicant is required to submit to the Village Clerk-Treasurer’s Office a cleaning/damage deposit (amount listed on page 1) each scheduled day of the event (or portion thereof) 5 business days prior to the starting date of the event. That deposit shall be refunded to the applicant, if, upon inspection, all is in order, or a prorated portion thereof as may be necessary to reimburse the Village for loss or cleaning costs. The Village reserves the right to retain the entire deposit if cleanup is not completed satisfactorily in the time frame as specified in the permit. Unless otherwise stated in the permit, the applicant shall be fully responsible for all necessary cleanup associated with the permitted event to be completed within 12 hours after the conclusion of the event.Termination of an EventThe Village reserves the right to shut down an event that is in progress if it is deemed to be a public safety hazard by the Police Department, Fire Department, and/or there is a violation of Village Ordinances, State Statutes or the terms of the applicant’s permit. The Village Administrator and/or his/her designee may revoke an approved community room use permit if the applicant fails to comply in good faith with the provisions of the permit prior to the event date.Date Date Format: MM slash DD slash YYYY Fees(choose all that apply)Weekday Rates - Resident (per day) Price: $65.00 Quantity: Weekday Rates - Non-Resident (per day) Price: $130.00 Quantity: Weekend Rates - Resident (per day) (Friday evening-Sunday, events up to four hours) Price: $100.00 Quantity: Weekend Rates - Non-Resident (per day) (Friday evening-Sunday, events up to four hours) Price: $200.00 Quantity: Weekend Rates - Resident (per day)(More than four hours on Saturday or Sunday) Price: $150.00 Quantity: Weekend Rates - Non-Resident (per day)(More than four hours on Saturday or Sunday) Price: $300.00 Quantity: Fees Total $0.00 Recurrent weekday events by the same group - Rate to be determined by Clerk's Office Civic Group/Not-for-profit Group - No FeeDeposit(choose all that apply)Weekday Event DepositPrice: $75.00 Quantity:Weekend (Friday evening-Sunday) Event DepositPrice: $200.00 Quantity:Weekend Weather Deposit (additional deposit for all weekend events Nov 1-March 31)Price: $100.00 Quantity:Key DepositPrice: $10.00 Quantity:Deposit TotalApplicant InformationName First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Daytime PhoneFaxEmail Organization InformationName of Organization Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneIs the organization a 501(c)3 organization?YesNoWebsite Rental InformationStart Date Date Format: MM slash DD slash YYYY End Date Date Format: MM slash DD slash YYYY Start Time : HH MM AM PM End Time : HH MM AM PM Estimated Number of ParticipantsPlease enter a number less than or equal to 131.NOTE: The room capacity is 131 people with chairs only, 65 people with chairs and tablesGenerally describe your event and its purpose.Will you be serving alcohol?If yes, temporary Class B beer and/or wine (picnic) and operator (bartender) licenses may be necessary under separate application.YesNoDoes your event involve amplified music/sound?YesNoIf yes, please describe below.Please describe your clean-up plan.What other assistance do you foresee needing from the Village (personnel, materials, equipment, etc.)?Click here to download a copy of the Village of Mukwonago Community Room Usage Policy & the Community Room ChecklistCertificationBy signing this form, the applicant certifies authorization to act on behalf of their organization, and hereby agrees to hold the Village, its officers, agents, employees, and contractors harmless against all claims, liability, loss, damage or expense (including but not limited to actual attorney fees) incurred by the Village for any damage or injury to person or property caused by or resulting directly or indirectly from the activities for which the permit is granted. Any change to coverage requires Village approval.SignatureName First Last Date Date Format: MM slash DD slash YYYY