FACILITY RENTAL Request OLD FORM DON'T USE

FACILITY RENTAL

REQUEST FORM
Please fill in the following information:
If you have any questions please contact us at 519-867-2651.
APPLICANT INFORMATION
Name of Organization/Group
Main Contact Person: *
Mailing Address: *
Email: *
example@example.com
Bus Phone:
Mobile #:
Alternate Contact Person:
Mobile #:
Email:
example@example.com
Type of Organization? *

Youth Adult
Are you a St. Clair Township based group? (more than 80% of participants are St. Clair Township Residents) *

YES NO
Type of User Group? *

League Pick-up Group Individual Contact Hockey Non-Contact Hockey Licensed Event Non-Licensed Event
Other Type of User Group? (No selection available above)
3rd Party Liability Insurance naming St. Clair Township on the policy is a requirement for any facility rental OR you can choose to be covered by a rider on St. Clair Township's Insurance Policy for an additional fee. If you have chosen St. Clair Township, you will receive a follow up call or e-mail with a quote based on the information you have provided on this form. *

Will provide my own insurance coverage and a copy of the Insurance Certificate will be provided prior to facility rental start date Would like to be covered by St. Clair Township policy rider for a fee
If you are providing your own insurance please enter the Name of Insurer, otherwise, enter "St. Clair Township" *
Number of Participants: (please enter the maximum # of participants that may be present at any given time) *
RENTAL REQUEST DETAILS

Rental Information: *

FACILITY RENTAL