KROC CENTER CHICAGO
LET YOUR KROC ADVENTURE BEGIN
POOL PARTY PACKAGE
(First two hours reserved for pool.
Last hour is your party)
Monday - Friday: 6pm - 9pm
Saturday: 12pm - 3pm / 4pm - 7pm
Sunday: 1pm - 4pm
W 119TH ST
W 118TH ST
W 119TH ST
4. For further questions, call our Events
Department.
Call the Events Department for Availability
Ph: 773-995-3313 | 773-995-3314 | FAX: 773-995-0161
HALSTED ST
W 118TH ST
MORGAN ST
3. Email the saved form to:
[email protected].
If you are completing the form manually,
please bring it to the Front Desk once
completed.
57
LOOMIS ST
2. If you complete the form from your
computer, make sure to save the file
before you email it to us. Otherwise, the
fields in the form will be blank.
th
1250 W. 119 Street
Chicago, IL 60643
ASHLAND AVE
1. Complete all the sections (I, II, III & IV)
and read/sign the rules and code of
conduct.
Location
Available Times
MARSHFIELD AVE
Instructions to complete
the Pool Party Request Form
W 119TH ST
POOL PARTY
PRICES SUBJECT
TO CHANGE
REQUEST FORM
PRINT
www.kroccenterchicago.org
I. Contact Information
Person Requesting Rental:
Today ‘s Date:____/_____/_____
Contact#:
Address:
City/State
Zip Code
E-Mail Address:
Alt. Contact #:
Honoree(Person event is for):
Name:
Age:
Gender:
M
F
II. Event Details
1st Choice:
2nd Choice:
3rd Choice:
Date:
Date:
Date:
Day/Time: Please select only one option
Monday:
6pm-9pm
Tuesday:
6pm-9pm
Wednesday: 6pm-9pm
6pm-9pm
Thursday:
Day/Time: Please select only one option
6pm-9pm
Monday:
6pm-9pm
Tuesday:
Wednesday: 6pm-9pm
6pm-9pm
Thursday:
Day/Time: Please select only one option
6pm-9pm
Monday:
6pm-9pm
Tuesday:
Wednesday: 6pm-9pm
6pm-9pm
Thursday:
Friday:
6pm-9pm
Friday:
6pm-9pm
Saturday:
Sunday:
12pm-3pm
1pm-4pm
Saturday:
Sunday:
12pm-3pm
1pm-4pm
4pm-7pm
Please select only one option
Room:
A
B+C
B
C
III. Package Options & Information
6pm-9pm
Saturday:
Sunday:
12pm-3pm
1pm-4pm
Please select only one option
Room:
A
B+C
B
C
4pm-7pm
Please select only one option
Room:
A
B+C
B
C
Please select only one option out of the four options below and next page
$250.00 Party Room A Party Package
includes:
16 People (total kids/adults)
3 Large Pizzas (Sausage, Pepperoni, Cheese or Veggie)
3 Pitchers of Lemonade or Punch
16 Vanilla ice cream cups
All paper products and spoons for ice cream, 3 balloons
Decorations are primary colors only
OR
16 Beef Hot Dogs (Turkey available upon request)
16 Bags of chips (plain)
16 Cups of Lemonade or Punch
16 Vanilla ice cream cups
All paper products and spoons for ice cream cups,
3 balloons
Decorations are yellow, green, blue, orange, and red.
$150.00 Deposit REQUIRED
4pm-7pm
Friday:
$375.00 Party Room B Party Package
includes:
25 People (total kids/adults)
4 Large Pizzas (Sausage, Pepperoni, Cheese or Veggie)
4 Pitchers of Lemonade or Punch
25 Vanilla ice cream cups
All paper products and spoons for ice cream, 3 balloons
Decorations are primary colors only
OR
25 Beef Hot Dogs (Turkey available upon request)
25 Bags of chips (plain)
4 Pitchers of Lemonade or Punch
25 Vanilla ice cream cups
All paper products and spoons for ice cream cups,
3 balloons
Decorations are yellow, green, blue, orange, and red.
$150.00 Deposit REQUIRED
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PACKAGES - CONTINUED; SELECT ONLY ONE OUT THE FOUR OPTIONS
Package Options & Information - continued
$325.00 Party Room C Party Package
includes (No direct access to pool):
- 25 People (total kids/adults)
- 4 Large Pizzas (Sausage, Pepperoni, Cheese or Veggie)
- 4 Pitchers of Lemonade or Punch
- 25 Vanilla ice cream cups
- All paper products and spoons for ice cream, 3 balloons
- Decorations are primary colors only
OR
- 25 Beef Hot Dogs (Turkey available upon request)
- 25 Bags of chips (plain)
- 4 Pitchers of Lemonade or Punch
- 25 Vanilla ice cream cups
- All paper products and spoons for ice cream cups,
3 balloons
- Decorations are yellow, green, blue, orange and red.
$150.00 Deposit REQUIRED
$650.00 Party Rooms B & C Party Package
includes:
- 50 People (total kids/adults)
- 8 Large Pizzas (Sausage, Pepperoni, Cheese or Veggie)
- 8 Pitchers of Lemonade or Punch
- 50 Vanilla ice cream cups
- All paper products and spoons for ice cream, 6 balloons
- Decorations are primary colors only
OR
- 50 Beef Hot Dogs (Turkey available upon request)
- 50 Bags of chips (plain)
- 8 Pitchers of Lemonade or Punch
- 50 Vanilla ice cream cups
- All paper products and spoons for ice cream cups,
6 balloons
- Decorations are yellow, green, blue, orange and red.
$325.00 Deposit REQUIRED
Price remains the SAME if ALL Children DO NOT attend.
Pizza Selection:
Type of pizza and number of each:
Cheese: _______
Pepperoni: ________ Sausage: ________ Veggie: _______
OR Hot Dogs Selection (One or the other; cannot be split):
Beef: _______
Turkey: ________
Beverage Selection:
Type of beverage and number of each:
Lemonade: ______ Punch: _______
Admin Notes Only:
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IV. Agreement
NOTE: Cupcakes or cakes may be brought into the facility but ALL other outside food & beverages
are NOT permitted. Due to regulatory health codes, food is NOT permitted to leave the Party Rooms.
All persons swimming must wear a LINED swim suit. Girls MUST wear a t-shirt over a two piece swim
suit. Chaperones MUST be present and within arm’s reach at all times for children 7 yrs old and
under. Children 11 yrs old and under MUST be accompanied by an adult. The KROC Community
Center is non-smoking facility. Drugs and/or alcohol are PROHIBITED.
Initial X: _____________
Additional Information:
Guarantee Number of Guests _____ Guests may be asked to leave if they exceed MAX capacity
Initial X: _________
Pool Party Room:
A - $250 (Deposit due: $150*)
B - $375 (Deposit due: $150*)
C - $325 (Deposit due: $150*)
B + C - $650 (Deposit due: $325*)
*Deposits due within 24 hours. Remaining balance due 7 days prior to your party.
TOTAL
Total / Final Balance
Please add the total here
All transactions must be made at the Welcome Desk or over the phone via the Events Department.
Deposit payment methods are debit/credit card with Visa, Mastercard, or Discover only. Cash or
debit/credit card can be accepted for final payments.
Terms, Guildlines & Liability:
All pricing and rates are subject to change. Deposit is due at the time of booking and is nonrefundable. No cash refunds will be given. ALL cancellations MUST be in writing. In the event you
pay for your party in full and you cancel the party 7 days prior to the date of the party you will be
refunded the total amount minus the non-refundable deposit. In the event the KROC Center
cancels the party you will be fully refunded **********************
Initial X: _______________
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By signing this document, I (we) agree to the following:
1. The renter, member and/or guest and the guest of the renter’s party will abide by the terms of this
agreement at ALL times during their visit and will comply with ALL rules and regulations posted or
otherwise communicated to the guest.
2. In case of illness, The Salvation Army KROC Center is authorized to secure emergency medical
treatment at the guest’s expense.
3. The Salvation Army KROC Center reserves the right to move from the facility and/or terminate
the membership/guest status of any member and/or your guest who fails to comply with ANY
posted rules and regulations or otherwise breaches the term of this contract, in which case the
member/guest will NOT be entitled to a refund of dues and/or fees.
4. Membership rights or guest pass status is NOT transferable.
I understand that the use of the facility and its equipment at The Salvation Army KROC Center may involve
risk of bodily injury and/or property damage and I agree to assume such risk. I understand that it is up to
me to consult a physician and any other professional to make sure I can safely participate in activities and
events at The Salvation Army KROC Center. I also understand and agree that by signing this agreement, I
am giving up my right and/or the rights of the minor(s) for whom I sign to make any claim against The
Salvation Army KROC Center, its agents, employees and volunteers, including the right to sue them for
bodily injury and or property damage or any other loss that might offer while using The Salvation Army
KROC Center facility, equipment and/or services, except as limited by law.
NOTICE: In order to promote a safe and secure environment, The Salvation Army KROC Center has placed
video cameras in various locations. As a part of our commitment to safety of children and vulnerable
persons, The Salvation Army KROC Center reserves the right to consult public sources to determine
whether any member and/or guest of any member, or guest generally poses an unreasonable risk of harm
to its patrons, staff and/or visitors.
PRINT NAME: _________________________________________________
SIGNATURE: __________________________________________________ DATE: ____/_______/_______
OPTIONAL:
Photo Release: I hereby, give permission for myself and my child to be photographed/videotaped for possibility of being used in The Salvation Army publicity
and I give exclusive rights to those photographs/videos to The Salvation Army and waive ALL claims for compensation for usage.
INITIAL: X__________
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GENERAL POOL RULES
NO one allowed in the pool area without a Lifeguard on duty.
Shower before swimming.
Remove ALL band aids and remember that if you have an open cut and/or wound, you should NOT enter
the pool.
Please have your children use the bathroom before entering the pool.
Children should wait 30 minutes after eating before entering the swimming area.
Running, pushing and house play are NOT permitted on the deck or in the pool.
NO dunking other swimmers at any time.
Lap swim in designated lanes in a counter-clockwise fashion.
Inflatable rafts, water guns or throwing toys are NOT permitted in the pool.
Children 11 yrs old and under MUST be accompanied by an adult.
Children 7 yrs old and under MUST have a guardian within arm’s reach at ALL times.
Floatation devices or fins are not allowed in the pool.
Keep head above water while in Vortex.
Feet first ONLY, NO diving allowed.
Profanity will NOT be tolerated.
NO smoking and/or alcohol in the pool area or facility.
Scube equipment is permitted ONLY in organized classes.
Kickboards, pull buoys, and hand paddles are for lap swimming and swim team ONLY.
Proper swim attire REQUIRED.
No street clothes, cut offs or shoes.
Infants and toddlers MUST wear approved swim diapers in the pool.
T-shirts are REQUIRED for two-piece swim suits.
NO glass, food and/or gum allowed in the pool area. ONLY plastic bottles with caps.
Pool furniture and beverages MUST remain along the walls of the pool area and are NOT allowed by the
edges of the pool.
Starting blocks are for swim team ONLY. Please refrain from hanging on lane markers, volley and/or basketball nets.
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GENERAL LOCKER ROOM RULES
Members and guests of ALL ages should use gender appropriate locker rooms.
Patrons with children of the opposite gender are REQUIRED to use the Family
Changing Rooms.
Personal items shoudl be LOCKED in a locker.
The Salvation Army KROC Center is NOT responsible for ANY lost and/or stolen items.
Locks may be purchased at the Welcome Desk.
Lockers are for daily use ONLY and locks left on a locker overnight will be removed.
Breakable objects, glass, food and gum are NOT permitted in the locker rooms.
Shower before entering the pool.
Do NOT use electrical devices in the locker rooms. Such devices include bur are not
limited to:
Cell Phones or Music Players
Tablets such as iPads
Cameras
Video Cameras
Graffiti in the locker room and/or bathroom area will result in suspension from facility
and subject to prosecution.
Starting blocks are for swim team ONLY. Please refrain from hanging on lane markers,
volleyball and/or basketball nets.
INITIAL: X_______DATE:____/____/_____
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HOLD HARMLESS AND INDEMNIFICATION AGREEMENT
In consideration of the privilege of using The Salvation Army’s property at :1250 West
119th Street, Chicago, IL 60643 by: ______________________________________
NAME OF INDIVIDUAL/ORGANIZATION)
we agree to assume the risk for any injuries, including death, that may be sustained by
members of our organization or any person invited as part of our group in connection
with the use of said premises.
Furthermore, we agree to indemnify, hold harmless, assume liability for and defend
The Salvation Army, its trustees, officers, members and agents from all costs and
expenses including, but not limited to, attorney’s fees, reasonable investigative and
discovery costs, court costs and any other sums which The Salvation Army, its trustees,
officers, members and agents may pay or become obligated to pay for injury, including death, to persons or damage to property resulting from our use of said premises
or from our actions or omissions and arising from any cause, including vehicles,
except for matters caused by negligence or willful misconduct of The Salvation Army
or its trustees, officers, members and agents while acting within the scope of duties of
such relationship to The Salvation Army.
I hereby certify that I have the authority to sign this agreement for the organization
identified above.
SIGNATURE: X______________________________________DATE:____/____/_____
SUBMIT FORM
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