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2. FACILITY REQUEST APPLICATION
   Please select from the following facility's in which you are inquiring.
4. Wackford Community Aquatic Complex

   1. Valley Oak Ballroom
   2. Teen Center
   3. Poppy Room
   4. Willow Room
5. Elk Grove Park

   1. Pavilion
   2. Strauss Island
6. Laguna Town Hall

   1. Reception Hall
   2. Courtyard
7. Albiani Recreation Center

   1. Lippincott Hall
   2. Swallowtail Room
   3. Monarch Room
9. APPLICANT CONTACT INFORMATION
   Name and DOB of individual responsible for event
11. First Name*
12. Last Name*
13. DOB
    Must be 18 to apply
15. Application on behalf of:*
    -- Select One --Individual Non-ProfitOrganizationBusiness
16. Name of Non-Profit, Organization or Business
18. Address*
20. City*
21. State*
22. Zip Code*
24. Phone Number*
25. Email Address*
27. ALTERNATE CONTACT
29. Name*
30. Email Address
32. Phone Number*
36. RENTAL INFORMATION
38. Type of Activity/Event:*
39. Approximate Attendance:*
41. Rental Date:*
    Rental Date:
42. Start Time*
    Start Time
    Rental times must include set-up and clean-up
43. End Time*
    End Time
    Rental times must include set-up and clean-up
45. TELL US MORE ABOUT YOUR EVENT:
47. Will Alcohol be served?*
    -- Select One --YesNo

    **Not allowed for any events that are honoring a minor**
48. Will Alcohol be sold?*
    -- Select One --YesNo
50. Will Food be served?*
    -- Select One --YesNoUnknown
51. Type of amplified Sound*
    -- Select One --In house Sound System (fee $50)DJBandSpeeches/AnnouncementsKaraokeOther
53. Are you requesting a Non-profit Rate?*
    -- Select One --YesNo
54. Will there be an admission fee?*
    -- Select One --YesNo

    **All admission fees need to be pre-collected/sold**
58. APPLICATION SIGNATURE
    Counterparts. This Agreement may be executed in two or more counterparts, each of which will be deemed an original but all of which together will constitute one and the same instrument. I understand that I will be contacted by a CSD representative within three business days from the date the application is submitted and that my application for the use of the facility is not final until a contract is signed and a payment is made. I attest that all the information provided in this application is true and correct.
60. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
62. Electronic Signature*
64. Date/Time of Submission *
    Date/Time of Submission

    Date/Time of Submission
65. How did you hear about our facility?*
    -- Select One --Social mediaActivity GuideFlyer/posterReferralGoogleOther
Leave This Blank:


67. 1. Receive an email copy of this form.
68. Email address

    This field is not part of the form submission.

69. Submit Submit and Print

* indicates a required field