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2. Janice Ward Facility Rental Application
   Please complete for rental of the Janice Ward Community Center. You need call the Government Center at 937-836-3500 prior to submitting an application to verify the date and time you are requesting is available. Application must be submitted with payment for rental date and time to be guaranteed.
4. Name or Group*
   First & Last Name or Group renting facility
5. Phone Number*
   Phone Number
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. Reason for Rental (i.e. baby shower, meeting, etc.)
17. Please advise the anticipated number of attendees for your party.
19. Date & Time Requested*
    Date & Time Requested Start Date

    Date & Time Requested Start Time

    —

    Date & Time Requested End Date

    Date & Time Requested End Time
    Requested date & time the facility will be rented. * Please include set-up & clean-up.
21. Rental Type*

    1. Resident ($25 per hour for each of the first 2 hours, $10 each hour after) Example: 4 hours would be $70.00 (1st 2 hours = $50.00 and the add'l 2 hours = $20.00). Proof of residency required.*
    2. Non-Resident ($40 per hour for each of the first 2 hours, $15 each hour after) Example: 4 hours would be $110.00 (1st 2 hours = $80.00 and the add'l 2 hours = $30.00)
    3. Business ($45 per hour for each of the first 2 hours, $15 each hour after) Example: 4 hours would be $120.00 (1st 2 hours = $90.00 and the add'l 2 hours = $30.00)
    4. Civic/Non-Profit Group
23. Acknowledgement *

    1. I have read and agree to the JWC Facility Use Policy.
    2. I have read and will follow the current State of Ohio Department of Health COVID-19 Health Orders while utilizing the facility.
25. Link to Document
    Facility Use Policy
26. Link to Document
    COVID-19 Health Orders
28. *Proof of Residency

    Please upload a picture of proof of residency.  Proof of residency may also be verified by emailing ldervali@clayton.oh.us or present proof at the Government Center.

    *Proof of residency includes valid driver’s license, state ID or utility bill. 

30. Submit Payment Online
    Online Payment Center

    Application must be submitted with payment for rental Date & Time to be guaranteed.
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field