APPLICATION FOR THE USE OF THE JOHN H. PIERCE HOUSE
(Please print out this form and mail it to the address provided at the bottom of this page or save and email to us.)
APPLICANT NAME:____________________________FUNCTION DATE:_______________
ADDRESS: ___________________________________HOURS WANTED: _________to______
TELPHONE:______________________
PRINCIPAL USER (if other than applicant)_____________________________________________
ADDRESS:_____________________________________________________________________
TELEPHONE: ______________________
RELATIONSHIP OF APPLICANT TO PRINCIPAL USER: _______________________________
CEREMONY TIME: __________LOCATION: _________________________________________
# GUESTS INVITED._______________ KITCHEN USE: ______________CHANGING RM:____
CATERER NAME:________________________________________________________________
TELEPHONE:______________________ ADDRESS:__________________ CITY/STATE ______
A $100 caterer deposit is required 1 month prior to function date and will be returned
after satisfactory
caterer/Pierce House manager checkout.
Band name:______________________________ Tele ____________________Hrs._____ to______
FIREPLACE USE: (Sept. to April) DINING ROOM __________ STUDY_________
Contact Pierce House manager for fireplace details and charges.
IS THIS FUNCTION OPEN TO THE PUBLIC OR A PRIVATE EVENT? IS ADMISSION TO BE CHARGED?__________
We the undersigned, have a copy of the REGULATIONS FOR 'THE
USE OF THE JOHN H. PIERCE HOUSE
and have read and understand the CANCELLATION AGREEMENT, GENERAL REGULATIONS, LIABILITY
TO PERSONS AND PROPERTY, PENALTIES FOR VIOLATIONS OF STATE LAWS, AND LICENSES OBLIGATIONS
and agree to abide by all the terms stated and further agree leave the Pierce House and
Property
in a condition comparable to that prior to our use.
APPLICANT SIGNATURE______________________________________________DATE________
PRINT NAME ________________________________________________________
PRINCIPAL USER_____________________________________________________DATE_______
PRINT NAME ________________________________________________________DATE________
Final confirmation of your reservation will be mailed within 7 days of receipt of this
completed form.
Call 781-259-9757 for further information or email
us.