Piqua Public Library
116 West High Street, Piqua, OH 45356
This Form acknowledges the below listed photographer and/or individuals/ groups who will be using the interior of the Piqua Public Library during the date and times listed. Restrictions are listed in the "Photographic and/or Audio/Visual Sessions in the Library Procedure."
1.) Individual/Groups using Library
Name_________________________________________________________________________
Email _________________________________________________________________________
Phone_________________________________________________________________________
2.) Photographer (audio/visual provider) using Library
Contact Person’s Name_______________________________________________________
Phone_________________________________________________________________________
3.) Day, Date, and Times of Use (Limit of 30 minutes)
Date ________________ Day ____________
Time ___________ a.m./p.m. to _____________a.m./p.m.
4.) Type of Event
Wedding _____ Family _______Individual Prom ______Team ________
Number of People Expected ________________________
5.) This form provides for use of the historical lobby and the marble stairs leading from it. Additional areas in the library must be approved individually.
Other Areas Requested ________________________________________
Date__________________
Will you enter the Library from: Front Door _______________ or Elevator _______
6.) Individual Requesting and responsible for use of the Library facility:
Name (print) ________________________________________ Date__________________
Signature ___________________________________________________________________
Library Approval
Name (print) ________________________________________ Date__________________
Signature ___________________________________________________________________