FACILITY RENTAL Request

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 (Full Name):*
Full Mailing Address:*
Primary Email:*
example@example.com
Primary Mobile #:*
Birthdate*

MonthDayYear
Date
Alternate Contact Person:*
Alternate Mobile #:*
Alternate Email:
example@example.com
Type of Organization?*

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

YESNO
Is your Organization Registered as a Not-for-Profit? If Yes, please supply your registration number.
Type of User Group?*

LeaguePick-up GroupIndividualContact HockeyNon-Contact HockeyLicensed EventNon-Licensed Event
Other Type of User Group? (No selection available above)
Valid Insurance Coverage is required for all Facility bookings. The Renter can provide a General Liability Certificate of Insurance naming "The Corporation of the Township of St. Clair" as an additional insured on the policy OR you can choose to be covered by a rider on St. Clair Township's Insurance Policy for an additional fee. Some Organizations may not be eligible for the additional rider coverage through the Township. Please review the Facility Contract before applying for General Liability Insurance.*

Will provide my own insurance coverage and a copy of the Insurance Certificate will be provided prior to facility rental start dateWould 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

Facility Requested

Rows	Facility Requested	Days of the Week	Start Date dd/mm/yy	End Date dd/mm/yy	Start Time	End Time	Used Last Year? (YES or NO)
#1
#2
#3
#4
#5
#6
#7
#8

Is there any additional information you would like us to know about your request?
Is there Set Up instructions you would like to add to the booking? (ex. Hall bookings - "set up tables and chairs" or Ice booking - "2 nets") Please be specific.
Personal information is collected under the authority of the Municipal Act, 2001 for the purpose of administering community programs and services in the Township of St. Clair. Questions about this collection may be directed to the Clerk, Township of St. Clair, 1155 Emily Street, Mooretown, ON, 519-867-2021.
Should be Empty:

FACILITY RENTAL

APPLICANT INFORMATION

RENTAL REQUEST DETAILS