Form Center

2. Apply to reserve a meeting room at the Ankeny Kirkendall Public Library!

4. Event Information
6. Date of Meeting / Event*
   Date of Meeting / Event
8. Please indicate any additional dates and times that you would like to rent the room.

   These dates are not guaranteed until you speak with a library representative. Please keep in mind our Meeting Room Policy (PDF).

10. Purpose of Event
12. Name of Organization
14. Is the organization governmental or have non-profit, tax-exempt status? *

    1. Yes
    2. No
16. Upload tax-exemption information, if applicable

    Maximum size allowed: 5 MB
    Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

18. Arrival Time (please include set-up)*
19. Number of people attending*
20. Departure Time (please include clean-up)*
22. Meeting Room (please select which room or room configuration you are interested in renting)*

    1. Room A (Capacity Approximately 50 with tables / chairs)
    2. Room B (Capacity Approximately 25 with tables / chairs)
    3. Room C (Capacity Approximately 25 with tables / chairs)
    4. Combined Rooms ABC (Capacity Approximately 75 with tables / chairs)
    5. Combined Rooms BC (Capacity Approximately 50 with tables / chairs)
    6. City Council Chambers (Capacity Approximately 50 with chairs only)
    7. I am uncertain, please contact me to help me decide.
26. Contact Information
28. Name
30. Address
32. City
33. State
34. Zip Code
36. Phone Number
37. Email Address
41. Additional Information
43. Do you plan to have food or alcohol at your event?*

    1. Food
    2. Alcohol
    3. N/A

    Check all that apply.

45. Do you need any of the following equipment / furniture / resources for your event?

    1. Microphone(s)
    2. Podium
    3. Digital projector and screen (AV control panel)
    4. Kitchenette Access
    5. Tables
    6. Chairs

    Please check all that apply.

46. Number of Tables
47. Number of Chairs
49. Library Disclaimers
    • I have read and agree to follow the guidelines and pay fees as listed in the Ankeny Kirkendall Public Library Meeting Room Policy.
    • I understand that there are a limited number of tables and chairs available. The library will do its best to provide the requested number, but I understand it is my responsibility to double-check that the library has enough prior to your event.
    • I understand I am responsible for the set-up and tear-down of equipment, furniture, etc.
    • I understand I am responsible to become familiar with the AV control panel and other equipment which will be used during my rental. The library staff will not operate the equipment during the event and no technical support is provided. (
    • I understand that I may need to contact staff prior to your event to be trained on the AV control panel)
    • I hereby acknowledge that I am responsible for the condition of the room(s) at the end of my event and am responsible for the cost of all damages. It is my responsibility to request a pre-event walkthrough if desired.
    • All events must end at the scheduled departure time. No event will end later than midnight Friday and Saturday at 8 pm. Sunday with no exceptions.
    • Alcohol Indemnification Clause: I hereby agree to hold harmless, indemnify and defend Ankeny Kirkendall Public Library and/or the City of Ankeny, its employees, agents, and representatives from any claims, costs including attorneys' fees, actions, arbitrations, lawsuits, and otherwise, arising out of or in connection with use or consumption of alcohol by me or anyone attending my function utilizing the Ankeny Kirkendall Public Library facilities. I acknowledge it is against the law to serve, provide, or make available alcohol to anyone under the age of twenty-one. I am solely responsible and liable for any damages that result from someone under the age of twenty-one consuming alcohol including, but not limited to, property damage, personal injury, death, or disfigurement to themselves, as well as property damage, personal injury, death, disfigurement, or loss of consortium to third parties.
    • Misrepresentation of the above data or failure to abide by the rules established will be cause for denial of further use of the meeting room
51. Please initial to acknowledge that you understand the previous disclaimers

    I have read and understood the above disclaimers.

53. Signature*

    Please type your full name to indicate your agreement and digital signature

54. Date*
    Date
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field