Los Altos Family YMCA
Room and Property
Date of Request________________
Name of Group______________________________________
Name of Activity/Event_________________________________
Contact Name_________________________
Phone Numbers______________________________________
Date of Event________________Times________________
Rooms Requested______________________
additional facilities needed? showers / kitchen
**Please note: Contact person is responsible for all set-up and clean-up. Special approval required for facility use outside of hours of operation.
Please contact Vicki Short with questions: 562-596-3394
You will be notified of your status ASAP.
OFFICE USE ONLY
Waivers Required? Yes / No
Fees Collected? Yes / No
Approval: Yes / No Staff Initials:________
Date Notified_________________
Comments_________________________________________
__________________________________________________
Date Notified_________________
Comments_________________________________________
_________________________________________