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Senior Center Facility Use Request

  1. Madison Senior Services Department

    29 Bradley Road, Madison, CT 06443

    Office (203) 245-5627  /  Fax (203) 318-0670

  2. This is a request for use of facility.  Do not make arrangements until final approval has been received from the Senior Services Office.

  3. Days
  4. Room Requested
  5. Will food & beverages be served?
  6. Will an admission fee be charged?
  7. Agreement*

    I understand, if approved, I will be required to execute an Articles of Agreement for Use and Release of Waiver of Liability and Indemnity Agreement. I further understand that I must abide by the times on the contract, and obey all rules and regulations pertaining to the facility being used.

  8. Thank You

    Thank you for your interest in reserving space in our building.  A member of our team will contact you.

  9. Leave This Blank:

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