FACILITY RENTAL Request Form

Please fill in the following information:
If you have any questions please contact us at 519-867-2651.

Name of Organization/Group

Main Contact Person:

Mailing Address:

Email:

example@example.com

Bus Phone:

Mobile:

Alternate Contact Person:

Mobile:

Email:

example@example.com

Fax:

Type of Organization?

Youth Adult

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

User Group Insurance

All user groups are required to carry and provide their own insurance when renting any St. Clair Township Facility.

The certificate of insurance is to Name the Township of St. Clair as an additional insured. Coverage required is COMMERCIAL GENERAL LIABILITY, inclusive of bodily injury and property damage, in the amount of $2,000,000.00 per occurrance and including Host Liquor Liability coverage, if required.

A copy of the Certificate of Insurance must be submitted with your signed rental/permit agreement.

Name of Insurer?

Number of Participants:

Rental Information: *

Facility Requested

Day of 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

** LEAGUES: Please identify playoff requests on separate form**

NOTES:

ICE RENTALS: Hourly Ice rentals are based on 50 minute ice time and 10 minute flood. Flood occurs at the beginning of your rental.

SPORTSFIELDS: Please attach pitching mound and base distance requirements.

Successful applicants will be sent a Facility Rental Contract that must be signed and returned with proof of insurance to the address above or e- mailed before the facility can be used. Please allow at least four weeks for processing of request (unless this is a last-minute booking)

The personal information on this form is collected pursuant to the Municipal Act in accordance with the Municipal Freedom of Information and Protection of Privacy Act, R.S.O 1990 for the purpose of the administration of tournament and special event requests. Questions regarding this collection should be directed to the Director of Community Services at 519-867-2651 or klindsay@stclairtownship.ca

FACILITY RENTAL

APPLICANT INFORMATION

RENTAL REQUEST DETAILS