Name of Group: Reservation Date: Zip: Phone (w) (h) Departure Time Person in Charge: # Expected Ages

Size: px

Start display at page:

Download "Name of Group: Reservation Date: Zip: Phone (w) (h) Departure Time Person in Charge: # Expected Ages"

Nelson Floyd
5 years ago
Views:

1 Dear Thank you for choosing the YMCA for your gathering. We are happy to have you and your group at our facility. Your group is scheduled to arrive on at. Enclosed you will find the Regulations for Use of Facilities and Equipment and/or Birthday Party Forms. Please sign it and mail it with your deposit to the Butler-Gast YMCA or drop off in person. Upon receipt of these items, we will be able to make the reservation for your special event. If your group is scheduled to use the pool, a waiver form is enclosed (please feel free to make copies). Each of your participants or parents of participants must sign this form in order for participants to swim. Please bring the waivers the night of the event. NO participant will be allowed to swim unless the permissions forms are present at time of rental. A deep water swim test is required by all participants 17 years and younger to swim in the deep end. We look forward to seeing you soon. Please call (402) if you have any questions. Butler-Gast YMCA 3501 Ames Ave Omaha, NE P: F: Web: YMCA Mission: To put Christian principles into practice through programs that build healthy spirit, mind, and body for all.

2 BUTLER-GAST YMCA - FACILITY RENTAL Revised may 2012 Today s Date: Staff: Name of Group: Reservation Date: Address: Arrival Time: Zip: Phone (w) (h) Departure Time Person in Charge: # Expected Ages Minimum 2 hours Facility Fee Teen Center $65/hour (electronic games, etc not available Gymnasium (Time ) $45/business hour (1/2 gym) $110 after hours Swimming Pool (Time ) $50/hour 1-20 people & $70/hr after business hrs $70/hour people & $90/hr after business hrs $90/hour 41+ people & $120/hr after business hrs Overnighter Includes gym, lobby area (Sat 7:00p-7:00a) o Gym, lobby area $400 o Pool (8:00p-11:00p) $ people $ people Security Deposit 25% of total due at time of booking (Non-refundable) Damage Deposit $100 refundable with no damage Special Instructions: PLEASE CAREFULLY READ the reverse side of the contract for facility regulations and ratios Groups are responsible for cleanup of areas used. Equipment, basketballs, volleyballs, & nets can be provided. Any lost or damaged equipment will be billed to the renting organization. The wellness center and kitchen areas are not available to any group. Office use only: posted in calendar Paperwork Sent Sent to build sup: copy to aquatics: Total Due Security Deposit Balance Due Date Paid Rcpt#

3 Swim Permission Form Child s Name: Age: Address: City: State: Zip: Home #: Emergency#: My child has permission to swim at the YMCA Yes No My child has permission to swim in the deep end. Yes No I understand that my child must pass a swim test (swimming two widths of the pool + 30 seconds treading water in the deep end) in order to swim in the deep end. If my child is 0-7 years old, there is to be an adult in the water with them at all times. If my child is 8-13 years old, there will be an adult watching from the pool side at all times. Adults are provided by the group. Adult that will be with your child: Party/Activity attending: I have read and understand the above: Parent signature: Date: This must be the parent/guardian signature only

4 Swim & Deep Water Swim Test Permission Name Age Swim Form Deep Water Form 1 YES/NO YES/NO 2 YES/NO YES/NO 3 YES/NO YES/NO 4 YES/NO YES/NO 5 YES/NO YES/NO 6 YES/NO YES/NO 7 YES/NO YES/NO 8 YES/NO YES/NO 9 YES/NO YES/NO 10 YES/NO YES/NO 11 YES/NO YES/NO 12 YES/NO YES/NO 13 YES/NO YES/NO 14 YES/NO YES/NO 15 YES/NO YES/NO 16 YES/NO YES/NO 17 YES/NO YES/NO 18 YES/NO YES/NO 19 YES/NO YES/NO 20 YES/NO YES/NO 21 YES/NO YES/NO 22 YES/NO YES/NO 23 YES/NO YES/NO 24 YES/NO YES/NO 25 YES/NO YES/NO Emergency Phone Parent/Guardian

5 OMAHA/COUNCIL BLUFFS YMCA RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT In consideration for being permitted to utilize the facilities, services, and programs of the YMCA for any purpose, including but not limited to observation or use of facilities or equipment, or participation in any program affiliated with the YMCA, without respect to location, the undersigned, for himself or herself and any personal representatives, hers, and next of kin, hereby acknowledge, agrees and represents that he or she has, or immediately upon entering or participating will inspect and carefully consider such premises and facilities or the affiliated program. It is further warranted that such entry into the YMCA for observation or use of any facilities or equipment or participation in such affiliated program constitutes an acknowledgement that such premises and all facilities and equipment thereon and such affiliated programs have been inspected and carefully considered and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use, or participation. IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER THE YMCA FOR ANY PURPOSE, UNCLUDING BUT NOT LIMITED TO OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY PROGRAM AFFILIATED WITH THE YMCA WITHOUT RESPECT TO LOCATION, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING: 1. THE UNDERSIGNED HERBY RELEASES, WAIVES, AND DISCHARGES AND COVENANTS NOT TO SUE the YMCA, its directors, officers, employees, and agents (herein referred to as releasees ) from all liability to the undersigned, his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefor on account of injury to the person or property or resulting in death of the undersigned, whether caused by negligence of the releasees or otherwise while the undersigned is in, upon, or about the premises or any facilities or equipment therein, or participating in any program affiliated with the YMCA, without respect to location. 2. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each from of them from any loss, liability, damage, or cost they may incur due to the presence of the undersigned in, upon, or about the YMCA premises or in any way observing or using any facilities or equipment of the YMCA or participating in any program affiliated with the YMCA whether caused by negligence of the releasees or otherwise. 3. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH, OR PROPERTY DAMAGE due to negligence of releasees or otherwise while in, about, or upon the premises of the YMCA and/or while using the premises and or any facilities or equipment thereon or participating in any program affiliated with the YMCA. The undersigned further expressly agrees that the forgoing RELEASE, WAVIER, AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by law of the State of Iowa or

6 Nebraska and that if any portion thereof is held valid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that nor oral representations, statements, or inducement apart from the foregoing written agreement have been made. I HAVE READ THIS RELEASE I HAVE READ THIS RELEASE / / / / Date Participant s Signature Date Parent/Guardian s Signature if participant Is legally a minor

FACILITY RENTAL APPLICATION *Application approval is based on facility availability, staffing demands and event specifics.

FACILITY RENTAL APPLICATION *Application approval is based on facility availability, staffing demands and event specifics. Name/: Date & Day of Event: Start Time: End Time: *see page 2 for set times available