Facility Booking Gymnasium Rental Request Form

Applicant Contact Information

Name(Required)

First Last

Are you making this request on behalf of an organization?(Required)

Yes

No

Organization Name(Required)

Address(Required)

Street Address City Province Postal Code

Primary Phone Number(Required)

Secondary Phone Number(Required)

Email Address(Required)

Insurance

All functions/events booked in Town facilities or on Town property require commercial general liability insurance. Insurance fees are in addition to the facility rental fee and are mandatory. Rates vary and will be determined at time of booking. The Town reserves the right to determine or amend the insurance requirements based on, but not limited to, risk assessment and event size.

Will you be purchasing Town of Ajax Insurance?(Required)

Yes

No (Permit Holder must provide a Certificate of Insurance 45 days prior to the event date.)

If a permit is created, how do you intend to make payment?(Required)

CASH/CHEQUE

DEBIT/CREDIT

Payment is due at time of booking.

Facility Booking Gymnasium Rental Request Form

Applicant Contact Information

Activity Information

Date Choices, Start and End Times

Insurance