Nyack, NY · Rockland County
Senior Center Usage Request
This agreement lets residents, businesses, and nonprofit groups request use of the Nyack Senior Center for a one-time event.
What this form is
Applicants use this agreement to request the Nyack Senior Center for a specified date, time, and event purpose, and to acknowledge their responsibilities for the premises and guests. The Village requires the completed agreement, liability insurance certificate naming the Village as additional insured, and applicable fees at least two weeks before the event. The form asks for applicant contact details, residency or business status, event information, and signatures.
Who needs it
Applicants over 21 requesting the Senior Center for an event must submit this agreement and show valid ID when submitting the request.
How to submit it
Return the completed agreement to the Village of Nyack Clerk at least two weeks before the event, with the required insurance certificate and fees. Applicants must show valid ID when submitting the request.
About notarization
This agreement is signed and dated without a notary; the document requires a liability insurance certificate, but does not say that it must be notarized.
How to submit this form
- 1
Download The Agreement
Download the Senior Center Usage Request for the event you are planning.
- 2
Complete The Request
Provide your contact details, applicant type, event date and hours, purpose, estimated attendance, and signature.
- 3
Gather Required Items
Include a liability insurance certificate naming the Village as additional insured, applicable fees, and proof of residency if claiming the resident rate.
- 4
Submit To The Clerk
Return the agreement and required items to the Village of Nyack Clerk at least two weeks before the event, and show valid ID.
Frequently asked questions
- Do I need a notary for the Senior Center Usage Request?
- No. The agreement is signed and dated without a notary. It requires a liability insurance certificate naming the Village as additional insured, but does not require that certificate to be notarized.
- How do I submit the Senior Center Usage Request?
- Return the completed agreement to the Village of Nyack Clerk at least two weeks before the event, along with the required insurance certificate and fees. Show valid ID when submitting.
- What must I include with the agreement?
- Submit a certificate of liability insurance naming the Village as additional insured and any applicable fees. Residents must provide proof of residency to receive the no-charge rate.
- How far in advance should I submit my request?
- The agreement says the request, insurance certification, and fees must be received by the Clerk at least two weeks before the event.
Need something notarized?
This Senior Center Usage Request doesn’t need a notary — but if you have another Nyack form that does, a commissioned online notary can help.