Carl Sandburg Middle School
1401 North Midlothian Road
Mundelein, IL 60060
& RECREATION P: 847 566.0650
F: 847. 566.8557
C O N N E C T I N G
O U R
855 W Hawley St, Mundelein, IL 60060
847.949.2707
C O M M U N I T Y
Carl Sandburg North Gym Rental Request
All fees must be paid in full in advance. Today’s date:
Applicant’s Name: DOB:
Organization:
(Person responsible)
(Date of birth)
Is the organization within the Mundelein Park District boundaries? Address:
Yes (*Must provide a certificate of liability insurance.)
No
City:
Primary Phone: State:
Alt. Phone:
Zip:
Email:
Day(s) and Date(s) requested:
Hours: Reason for rental:
to Equipment needed:
Number of attendees expected: Average age of attendees: Will there be an admittance fee to this event?
Yes
No
Rental Availability Day/Time:
Calculate Rates:
Monday – Friday: 6:15 pm – 9 pm
Saturday – Sunday: 9 am – 9 pm
Resident Fee : Total Hours
*Organization provided a certificate of
liability insurance. Yes No
Non Resident Fee: Total Hours
X $30.00 $
–or–
X $45.00 $
Total Due Today $
RENTER RESPONSIBILITIES: The Person/Organization Agrees To The Following:
1.
If you are an organization, using any MPRD Facility, you will be required to
provide us with a $1,000,000.00
Certificate of Liability Insurance, naming the Mundelein Park District as
additionally insured on the policy.
2.
Clean up garbage and put away equipment 15 minutes before scheduled
end time.
3.
Renter will vacate property at, or before, scheduled end time.
4.
The Park & Recreation District is not responsible for any lost or stolen
items.
5.
The Park & Recreation District is not responsible for any injury or loss that
occurs before, during, or after the rental on park district property.
6.
Gambling of any form will not be permitted.
7.
Closing hours for all park district buildings is 9 pm unless otherwise
approved
8.
NO SMOKING ALLOWED IN THIS FACILITY.
9.
NO ALCOHOLIC BEVERAGES will be consumed or brought on the premises.
10. REFUNDS WILL NOT BE ISSUED FOR UNUSED TIME.
For office use only
Cash
Check # Credit:
Approved
MC
Visa
Disc
AMEX
(Auth#
) Registered/Entered by:
Denied By:
D ate: Signature of Applicant:
Charge To:
MC
Date:
Visa
Account #:
Cardholder Name:
Carl Sandburg Gym Rental Agreement
Disc
AMEX
Exp. Date:
Security Code:
Charge Amount:$
Signature:
Revised 10/2016