YMCA Building Rental Request COA# 0109011640 Name of Organization: Address: Name of Supervisor: Business Phone: Name of Group

or Event: Date of Event: Arrival Time: Number of Participants: Number of Supervisors:

Set Up Time: Departure Time: Ages: Number of Swimmers:

Meeting Room(s) Member/Non-Member $ 60/75 per hour (1rm) $ 75/90 per hour (2 rm) Same as above DOES NOT APPLY DOES NOT APPLY $50/hr. (min. 1 hr.) $25 (0-50ppl)/$50 (50+) $25 per console Entire Facility Member/NonMember $100/120 (0-50 ppl) per hour $130/150 (0-50 ppl) per hour $ 140/175 per hour $ Discussed by director Same Same Same Start Time End Time

Entire Facility Sunday-Thursday Fri-Sat 51-100 100+ DJ (Min. 1 hr.) Slushies (unlmtd. Refill) Game Consoles Total Cost

Cost

Meeting Room Rental Designed Area This fee schedule is for the use of C.O. Miller Teen Center meeting rooms and includes use of restrooms and kitchen if necessary. Facility availability is based on other scheduled YMCA programs and activities. Entire Facility Rental The package is intended for organized groups to use the entire C.O. Miller Teen Center facilities including the outdoor pavilion, restrooms, kitchen, meeting rooms (if available) and gaming area.
Please check your request for additional needs: _____ Projector* *Computer must be provided by the group _____ Tables (YMCA has 15 8 ft rectangle and 6 circular tables)* _____How many rectangle tables needed? _____How many circular tables needed? *Groups must provide their own table cloths _____ Chairs ____How many chairs are needed?(Up to 200) _____ Use of kitchen (ice machine, refrigerator, etc) _____ Additional set up time needed for event (additional cost will apply as needed)

Estimated Cost:$ 50% Reserve Deposit:$ (required for reserving Date) $50 Damage and Cleaning Deposit (due for exclusive facility rentals only): $ Damage and cleaning deposit ($25) will be returned after rental if there are no damages and if clean up is not required.

Facility Agreement The YMCA maintains its building, equipment and facilities primarily for use by the members of the Hickory YMCA. Rental to non YMCA groups or individuals may be permitted, provide the guidelines listed below are closely followed: 1. Groups or individuals may not use the building for the purpose of selling their products or services directly to the public. 2. The use of the YMCA facilities does not imply endorsement or sponsorship by the YMCA. 3. Food and beverages must remain in the area (s) designed by the YMCA staff. 4. No smoking or other use of tobacco products is allowed on the premises. 5. Alcoholic beverages or any illegal substances are not permitted. Anyone under the influence of alcohol or illegal substances may not remain on YMCA premises. 6. Participants or supervisors are expected to clean those areas that they use, leaving them in the same condition as they were found prior to the start of the rental. If clean up is left undone, all or part of the damage/cleaning deposit will not be returned. 7. Any damages done to the building, facilities or equipment during the rental will be the responsibility of the organization and the supervisor. 8. Participants are limited to use of those areas of the YMCA facility that are included in the rental agreement. It is the responsibility of the supervisor to keep participants out of all other areas. 9. The YMCA reserves the right to cancel or dismiss any rental. The YMCVA will issue a refund if the YMCA cancels the rental in advance, however if the YMCA dismisses a rental for violations of the rules and regulations of the YMCA, no refund will be issued. 10. Any decorations should be approved in advance, and their use must not leave any marks upon removal, or damage fees will be assessed. 11. All participants and supervisors must follow the directions of the YMCA staff persons in charge. 12. In the event of cancellation by the renting organization, deposits may not be refunded if notice is not given a minimum of two weeks in advance of the rental date. 13. Any and all music played at the center shall be deemed appropriate by the rental host as needed according to the YMCAs positive focus and mission. 14. Rental groups will be provided one hour set-up and 30 min. tear down time. 15. The YMCA is not responsible for loss of personal property on the premises. 16. Groups shall not charge admission fees for events hosted unless approved by facility director. By my signature below, I certify that I have read the requirement, rules and regulations, and that I fully understand and freely agree to these conditions.

Signature

Date

Name (Print)

Phone Number

Executive Director

Date