White Chapel Reservation Form – Burtchville Township

Burtchville Township Little White Chapel

3906 Burtch Road, Lakeport Michigan 48059 Phone: (810) 385-5577 Fax: (810) 385-8551

Rental Application and Agreement

For Weddings

This agreement is not final until fees are paid

Rental Fee: $100.00 Deposit: $50.00 Non-Refundable Cleaning Fee: $50 Total Due: $200.00
Make Check payable to Burtchville Township.
You must be a resident to reserve.
Printable Form

* Indicates required fields

Your Name*
Your Email*
Person applying for use*
Address*
City*		State*
Contact Person*	Phone*

Description of use*:

Date of Event*:

Time to Open*:

Time to Close*:

INDEMNITY BY APPLICANT The Applicant acknowledges receipt of a copy of the Policies and Rules and agrees to comply. Applicant shall indemnify the Township and save it harmless from and against any and all claims, actions, damages, liability and expense in connection with loss of life, personal injury and/or damage to property arising from or out of the occupancy or use by Applicant of the premises or any part of the Township property occasional, wholly or in part, by any act or omission of Applicant, its agent, contractors or employees. I, HEREBY, AGREE TO THE FOREGOING TERMS AND CONDITIONS OF THIS AGREEMENT