Facility Rentals Application Form 4750 57th Street, Delta BC V4K 3C9 Phone: 604.952.5335 Application to be submitted a minimum of 7 days prior to date(s) requested. Cancellations/Changes inside 7 days of confirmed dates will require payment in full. All fields must be completed. Incomplete forms will not be accepted. Facility RequestEvent/Activity:Number of Attendees:Age (if youth group):Facility (school) requested:Burnsview SecondaryDelta SecondaryDelview SecondaryNorth Delta SecondarySands SecondarySeaquam SecondarySouth Delta SecondaryAnnieville ElementaryBeach Grove ElementaryBrooke ElementaryChalmers ElementaryCliff Drive ElementaryCougar Canyon ElementaryDevon Gardens ElementaryEnglish Bluff ElementaryGibson ElementaryGray ElementaryHawthorne ElementaryHeath Traditional ElementaryHellings ElementaryHolly ElementaryJarvis Traditional ElementaryLadner ElementaryMcCloskey ElementaryNeilson Grove ElementaryPebble Hill Traditional ElementaryPinewood ElementaryPort Guichon ElementaryRichardson ElementarySouth Park ElementarySunshine Hill ElementaryDMEC (Delta Manor Education Centre)Alternate facility (school):Burnsview SecondaryDelta SecondaryDelview SecondaryNorth Delta SecondarySands SecondarySeaquam SecondarySouth Delta SecondaryAnnieville ElementaryBeach Grove ElementaryBrooke ElementaryChalmers ElementaryCliff Drive ElementaryCougar Canyon ElementaryDevon Gardens ElementaryEnglish Bluff ElementaryGibson ElementaryGray ElementaryHawthorne ElementaryHeath Traditional ElementaryHellings ElementaryHolly ElementaryJarvis Traditional ElementaryLadner ElementaryMcCloskey ElementaryNeilson Grove ElementaryPebble Hill Traditional ElementaryPinewood ElementaryPort Guichon ElementaryRichardson ElementarySouth Park ElementarySunshine Hill ElementaryDMEC (Delta Manor Education Centre)Room Request: Gymnasium Cafeteria Library Theatre Multi-Purpose Classroom Parking Lot Exterior Undercover Day(s) of the Week: Monday Tuesday Wednesday Thursday Friday Saturday (weekend/holiday 4 hr min custodial payment applies) Sunday (weekend/holiday 4 hr min custodial payment applies) Start Date: Date Format: MM slash DD slash YYYY End Date: Date Format: MM slash DD slash YYYY Start Time: (access and departure times must be strictly adhered to) : HH MM AM PM End Time: : HH MM AM PM Special Requests(Approval required through Facility Rentals, such approval written into the permit)Special Requests: Food/Beverage Alcohol (Delta School District approval and applicable liquor permit required) Equipment (approval in writing required through Facility rentals, including tables/chairs) Please indicate types of equipment required:Account Information(Primary Contact will be named on the permit and responsible for all cancellations, changes, ensuring timely payment processing and communications with Facility Rentals)Organization/Society/Private Name:Organization type:For ProfitNon-Profit (non-profit number upon request)Private (family/social)Liability Insurance Provider:Primary Contact Name: First Last Primary Contact Email: Primary Contact Address: Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Primary Contact Cell Phone Number:Primary Contact Alternate Phone Number:Secondary Contact Name: First Last Secondary Contact Email: Secondary Contact Cell Phone Number:Secondary Contact Alternate Phone Number:Terms and Conditions: By checking this box, the Undersigned, having read the Terms & Conditions Governing Use of School Facilities, including the District COVID-19 Safety Plan: Highlights Affecting Rental Groups, agrees to the Terms & Conditions and Safety Plan. Type your name here:Select today's date: Date Format: MM slash DD slash YYYY
