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

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1 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 Area of Facility Needed: Indoor Pool / Outdoor Pool / Gym /Multi-Purpose Room / Conference Room Kool Kidz Studio / Aerobic Studio / Lock-In / Educational Rental Total Number Attending: Age Range: *Max 20 swimmers for pool parties including chaperones for non-swimmers 6 Tables Needed: Chairs Needed: TV/DVD Needed: Youth Birthdays receive one Y Party Tee: 6-8 sm med lg. Name of Birthday Person: How Old: Name of Responsible Adult: Birthdate (MM/DD/YYYY): (must be 21 years or older) Mailing Address: City: State: Zip: Address: Y Member Non-Member Day Phone: Night Phone: Cell: Facility Rental Application I, the undersigned, as the responsible person for this event, have read, understand and agree to abide by the Y policies and procedures. My group/attendees will also abide by these same policies and procedures or I will make sure that they vacate the Y premises immediately. I assume all charges and expenses required and/or acquired for the rental event. Any damages incurred above the $50 deposit will be paid in full by me within 48 hours of notification. The Y will not be held responsible for loss, liability, additional cost, obligation or bodily harm. I agree to follow the rental application details as approved by the Y staff and myself. The deposit will not be applied or returned if clean-up is not appropriate or damages occur. The Y has the right to cancel, change, alter or terminate this agreement if circumstances provide reason. Responsible Adult: Signature: Fees/Charges: *adjustments or changes may be calculated due to the nature of the request. Once set and agreed upon, cost should be firm. Approved rentals that are cancelled by the renter two weeks prior to the date will be reimbursed the total amount. Cancellations with less than a two week notice will forfeit their deposit to the Y. Deposits are submitted with application on a separate check and returned after the party if agreement is followed. If clean-up does not occur, damages happen or the agreement is not followed, the deposit will be forfeited to the Y.

2 BIRTHDAY PARTIES: The Y will supply the tables and chairs. Please bring table clothes to cover the tables. The Y does not provide a refrigerator, napkins, plates, utensils, etc. so please plan to bring a cooler and paper products needed for your party. Food and decorations are welcome, but please keep in mind that only 15 minutes is allotted before and after your party for set-up and clean-up. Indoor Pool Party: $50 deposit required; includes 1 hour in swimming pool followed by one hour in multi-purpose room; available September 1 st -May 21 st * The Multi-purpose Room may be used for refreshments and/or gifts, when available, which is included in the price and must be used within the approved rental time slot. It must be used after pool use, not before, during or in between. Outdoor Pool Party: $50 deposit required; includes 2 hours use of outdoor swimming pool and picnic pavilion (available after Memorial Day through Labor Day) *check inclement weather policy Tuesday 5pm to 7pm $125 Y Members $150 Program Members Thursday 5pm to 7pm $125 Y Members $150 Program Members Friday 5pm to 7pm $125 Y Members $150 Program Members Saturday 10:30am to 12:30pm $125 Y Members $150 Program Members Sunday 1:15pm to 3:15pm $125 Y Members $150 Program Members Sunday 3:30pm to 5:30pm $125 Y Members $150 Program Members Gym Party: $50 deposit required; includes ½ gym for 2 hours Sunday 2:00pm to 4:00pm $125 Y Members $150 Program Members FACILITY RENTALS: Special events are individually assessed, approved, and must be scheduled with a full-time staff member. Rental application and deposit must be completed. Rentals are not exclusive and do not have exclusive use of our facilities. Rentals are scheduled during regular operating hours while other activities may be scheduled. ½ Gymnasium: $50 deposit required; includes private use of ½ of our gymnasium $50/hr Y Members $75/hr Program Members Aerobic Studio: $50 deposit required; includes private use of our Aerobic Studio $50/hr Y Members $75/hr Program Members Conference Room: $50 deposit required; includes private use of conference room Free Y Members $25/hr Program Members Multi-Purpose Studio: $50 deposit required; includes private use of our Kool Kidz Studio $15/hr Y Members $25/hr Program Members

3 Lock-In: $50 deposit required; available Friday or Saturday nights from 9pm-6am; includes 2 hours of pool time from 10pm-12am with a 2 certified lifeguards $400 Y Member $450 Program Member Educational Rentals: includes rental space for educational programming in various parts of the building to be determined by renter and YMCA staff. $100 for 8 weeks (1 hr per week) $150 for 8 weeks (2 hrs per week) Office Use Only: Please make all checks payable to the YMCA. $50 Deposit Paid: (Will accept credit card to be left on file or a separate check attach to application. NO CASH) Rental Payment: Amount Paid: $ Staff Person Receipting: (MUST PAY AT THE TIME PARTY IS BOOKED)

4 YMCA OF EAST TENNESSEE 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, heirs, and next of kin, hereby acknowledges, 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, 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 HEREBY AGREES TO THE FOLLOWING: 1. THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the YMCA, its directors, officers, employees, and agents (hereinafter 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 the 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 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 the 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 or any facilities or equipment thereon or participating in any program affiliated with the YMCA. THE UNDERSIGNED further expressly agrees that the forgoing RELEASE, WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State of Tennessee and that if any portion thereof is held invalid, 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 INDEMNITYAGREEMENT, and further agrees that no 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 s or guardian s signature (if participant is legally a minor) Please give to Member/Guest at sign up. Please read BEFORE party

5 Your Pool Party is not a private event; there will be others in the pool! Rental Guidelines & Policies 1. The possession and use of alcohol, tobacco products and/or illegal drugs are NOT permitted in or on the Y property at any time. Abuse of this policy will result in lawful prosecution. 2. All rental event participants, guest and spectators are responsible for their behavior and the behavior of the group. The designated adult responsible for the event will enforce all Y policies and guidelines. 3. The rental event adult designated in charge must be 21 years old or older, have completed the rental agreement, paid all fees prior to rental start time and have been approved by the Y. 4. The rental event group may arrive no earlier than 15 minutes before the scheduled event time. If additional set-up time is needed, prior arrangements must be made with the Y. Abuse of this policy may result in forfeiture of the deposit. 5. The rental event group must be cleaned up and leave the premises no later than 15 minutes after the event s approved ending time. Abuse of this policy may result in forfeiture of the deposit. 6. There will be no food or drink, with the exception of bottled water, allowed on the Indoor Pool deck area during the event. 7. Rental participants under the age of 14 years must be swim tested by a Y staff before entering the pool. All event participants may be kept out of the pool until all swim testing is done. 8. Personal items of value are the sole responsibility of the group and not the Y. Lost, stolen or damaged items are not the responsibility of the Y or its representatives. 9. The Y Inclement Weather Policy will be enforced and must be followed without hesitation or complaint. All cancellations due to weather will result in a refund, system credit or selection of another date for party. The Aquatic Director will handle these requests. 10. The Y has the right to cancel, change, alter, or terminate rental events when circumstances require. 11. Max number of swimmers not to exceed 20. Pool Rules 1. Any child who requires the use of a floatation device MUST have a parent/guardian present in the water or within arm s reach of the child. 2. Any child under the age of 8 must have a parent/guardian (16 years or older) with them in the pool area at all times. Children ages 8 to 13 must have a parent/guardian present on Y property. 3. No street clothes; please wear appropriate swimwear. 4. No running, diving, rough play, profanity, gum, cotton t-shirts, diapers, public displays of affection, unapproved floats, or underwater breath holding. 5. Lap lanes are for lap swimmers only 6. If you hear one long whistle blasts, please CLEAR THE POOL IMMEDIATELY. 7. Have fun!!! Supplies: The Y will supply the tables and chairs. Please bring table clothes to cover the tables. The Y does not provide a refrigerator, napkins, plates, utensils, etc. so please plan to bring a cooler and paper products needed for your party. Food and decorations are welcome, but please keep in mind that only 15 minutes is allotted before and after your party for set-up and clean-up.