General Information: First Name: * Are You making this request on behalf of an organization? (Yes/No):* Phone Number (Primary):* E-mail: * Apartment: Street Name: Province: Last Name: * Have you rented from Vraj Community Services before? (Yes/No): Phone Number (Secondary): Best method of contact: Street Number: City: Postal Code: Organization Details: Name: * Phone:* Address:* Province: E-mail:* City: Postal Code: Rental Information: Description:* Please provide a description of the activities that will take place during your event. Preferred Start Time: Expected Attendance: Preferred End Time: Age Range of Attendees: Insurance Requirements:* All users are required to obtain and maintain insurance coverage in the amount of $2,000,000 for public and general commercial liability insurance, and must name Vraj Community Services as additional insured. Special Requirements/Comments: Please provide any special requirements or comments. How did you hear about our venues? *Questions about this collection should be directed to the Manager, Customer Service Centre, 16903 Hurontario Street, Caledon, Ontario, telephone 905-615-3200, ext. 5037. Date: Participants Name: Participants’ Signature: Date: Official VCS Authority Name: Official VCS Authority Signature: I agree that my data is used according to the Terms and Conditions. 95640
