EmailMe Form - Rental Request - West Park-Fairview Family YMCA

Section A

Applicant Information

Name *

First Last

Business/Organization (if applicable)

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone 1 *

### - ### - ####

Phone 2

### - ### - ####

Email *

FOR BIRTHDAY AND OTHER PARTY RENTAL REQUESTS, PLEASE PROCEED TO SECTION C

Section B

Facility rental Information (please see website for specific details and pricing information of each space)

Room requested for meeting (check option) *

Gym

Aquatics Facility

Community Room

Date and Time of Request *

MM / DD / YYYY HH : MM AM/PM

Equipment Needed *

TV/DVD Player

Screen

Tables/Chairs

Other

Section C

Party Rentals (all party rentals held after hours. Please consult website for details)

Age(s) of Party Participants *

Date of Rental Request (First Choice) *

MM / DD / YYYY

Date of Rental Request (Second Choice) *

MM / DD / YYYY

Estimated Number of attendees (final count to be confirmed the week of event.) *

Location of Party Request (in addition to party room) *

Gym

Pool

Gym Equipment Requested *

Kick Balls

Basketballs

Soccer Balls

Note to Applicant

Please note that this is NOT a contract for the date requested. Staff will contact to confirm date within 3 business days of receipt of request. Requests must be received at least 7 business days prior to the date of request to provide staffing.