Before signing and submitting the following forms, applicants must read and agree to abide by Town of Cummington Fees and Requirements for Building Use. That document also contains information about rental fees.

1. Application for Short-Term Private and Community Facilities Use
2. For-Profit User Agreement (for For-Profit Users, Resident or Non-Resident)
3. One-Day Liquor License Policy (If applicable)
4. One Day Liquor License Application (If applicable)
5. Release of Claims, Indemnity and Hold Harmless Agreement (required for all non-municipal rentals)

The completed forms may be submitted in person or by email attachment to the Community House Coordinator, chcoor@cummington-ma.gov, at the Town Clerk office, 33 Main Street or by mailing to Community House Coordinator, PO Box 128, Cummington, MA 01026.

Application for Use

Name: _____________________________________

Telephone: ______________

Email: ______________

Address: ___________________________________________________________ Group/Organization: ____________________________________________

Date(s) and Times requested: _______________________________________

Number attending (approximate): ____________________________________

Space requested:

Kitchen/Dining Room _____

Auditorium ______

Library ______

Selectboard Room (Municipal use only) ___________

Reason for use of space:

Events/Ceremonies Resident ______

Events/ Ceremonies Non-Resident_______

For-Profit Rental Resident ______

For-Profit Rental Non-Resident_______

Town Sponsored/Municipal Use (No Fee) _______

Non-Profit Civic Groups ($10.00/hr)___________
Frequency (Note: applicant must complete the Online Calendar form for specific dates/times located on the Town of Cummington website)

 One-time only Date of event _____________

Start time ___________

End time __________

Regular use Interval _______________ (weekly, monthly, every other month)
Start time ________________ End time ________________
Start date________________ End date ________________

Expected attendance (maximum) _______
Police Detail required? Yes ___ No ____
Will minors attend without parents? Yes ____ No ____
If yes, Name of Second Adult Supervisor__________________________________________

Amount of fee enclosed: ________________________________________

Please note all scheduling is done on a first come – first served basis upon receipt of fee. See attached fee schedule and rules for Community House use.

Please return completed application along with Rental fee and Security Deposit (separate checks made payable to the Town of Cummington) to Community House Coordinator: Brenda Emerson-Camp, Town Clerk
Cummington Community House P.O. Box 128, 33 Main Street, Cummington, Ma 01026 Rev. 3/2023