Name of Group/Org: ____________________________________________________________ (The lessee)


Contact Person: ___________________________  

Mailing address: ___________________________  



Position:  _________________________________

Email address: ____________________________

Home Phone: _____________________________

Cell Phone: _______________________________



Lessee will acquire a Special Occasion Permit from LCBO if providing alcohol in the facility

If alcohol is being served, lessee agrees to purchase Lessee Liability Insurance from their Insurance Broker for the Chepstow Community Hall (445 Chepstow Road, Chepstow, ON, N0G 1K0) of no less than $1,000,000 and agrees to provide Proof of Liability at time of rental.



Rental Date: ________________________________

Time of Event: _____________________


Purpose of Rental: ___________________________

Crowd Size: _______________________




Facilities Required:   Hall             Pavilion               Kitchen               Bartenders               


Caterer: ___________________________________

Other: ____________________________________


Equipment:   Tables              Chairs              Picnic Tables               Other           


Basic Rental Fees:

Hall - $130

Pavilion - $60

Kitchen - $70

Bartenders / Security - to be determined



Total Rental $ ___________________

Deposit Made $ __________________

Balance Due $ ___________________



Fees are payable in full to the Lessor 15 days before the function. Damage / security deposit will be asked for in the amount equal to the rental charge.


Covid Protocols: Lessee will adhere to current Provincial Government or Grey Bruce Health Unit Covid regulations at time of rental.

A list of attendees for contract tracing to be compiled upon entry of facility including phone numbers and / or addresses.



The undersigned Lessee hereby agrees to rent the above facilities at the rental fee shown, subject to and in accordance with the conditions of this contract. The lessee confirms by way of signing, that they have read and understood this contract, and have purchased, or have the necessary insurance coverage for this event. (Please attach confirmation letter from your insurance company). Applicant acknowledges that he/she represents the Lessee and agrees to personally guarantee the fulfillment of this rental contract.






(Signature of Lessee)








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