Facility Rental Request
YMCA of Northern Rock County
Name:
*
First Name
Last Name
Organization Name (if applicable):
Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email:
*
example@example.com
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Event Information
A two-week notice is requested. Rental is not guaranteed until date is confirmed and the deposit is received.
Date:
*
-
Month
-
Day
Year
Date
Second Choice Date:
-
Month
-
Day
Year
Date
Requested Event Time:
Hour Minutes
AM
PM
AM/PM Option
Estimated number of Chaperones/Adults:
*
Estimated number of Participants:
*
Janesville YMCA
Please select all requested areas of use:
Full Facility
Parker Hall Gym
Main Gym
JP Cullen Gym - Side A
JP Cullen Gym - Side B
JP Cullen Gym - Full Gym
Multipurpose Room
Cycling Studio
Party Room
Other
If you chose 'other' above, please explain below:
Parker YMCA (Milton)
Please select all requested areas of use:
Full Facility
Patricia Jeffris Gym
Multipurpose Room
Other
If you chose 'other' above, please explain below:
Equipment Requests
Do you need any specific equipment for your rental?
Volleyball Nets
Pickleball Nets
Scoreboards
Other
Special Set-Up or Equipment Request/Notes Regarding Rental:
Please verify that you are human
*
Submit Survey
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