2. 
4. Full Name*
5. Email Address*
7. Address*
8. City, State*
9. Zip Code*
11. Phone*
12. Driver's License Number
14. Date of Event Desired*
    Date of Event Desired
15. Time of Event Desired*
    Time of Event Desired Start Time

    —

    Time of Event Desired End Time
17. Type of Event*
18. Number of Guests*
19. Will Alcohol be served?*
    -- Select One --YesNo
21. Which room are you desiring to rent? (Please check all that apply)*

    1. Multi-Purpose
    2. Gymnasium
    3. Activity Room
    4. Kitchen
    5. Outdoor Patio
22. Number of Tables & Chairs Needed
24. Rental Room Addendum COVID-19 Regulations
    In consideration of myself and/or my guests being allowed to participate in any said facility rental, I grant the Village, its officials, agents or employees full permission to do a temperature scan on myself and/or my guest and monitor for symptoms of COVID-19, which may include being asked a series of questions. I understand and agree that if I and/or my guest has a temperature, shows symptoms of COVID-19 or answers any questions in the affirmative, I and/or my guest shall not be allowed to participate in any Village of Richton Park activities. Face coverings are mandatory to be worn during the event, along with 6ft social distancing and only 50 participants are allowed. In addition, Village staff will be present for the rental, monitoring, and cleaning purposes. If these terms are not adhered to the rental will be terminated immediately with NO REFUND. Extension of Participant Liability Waiver and Hold Harmless Agreement. I hereby agree and understand that the terms and provisions of the Participant Liability Waiver and Hold Harmless Agreement contained on the Registration Form is extended to include COVID19 exposure, infection or the monitoring of COVID-19 exposure as provided above.
26. Electronic Signature Authorized*

    1. YES
28. Upon submission, you will be contacted for date availability, and further instructions.
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field