Form Center

2. 

3. 
   

   
   
   800 Waterloo Road
   Warrenton, VA 20186
   (540) 349-2520

5. Name*
6. Date*
8. Address*
10. City*
11. State*
12. Zip*
14. Home Phone
15. Cell Number*
17. Email Address*
19. Event Description*
21. Child's Name*
22. Age*
24. Number of Participants to Attend*
25. Age Range of Participants*

27. *1 swimming adult for every 5 children ages 5 and under; 1 swimming adult for every 8 children ages 6 and older*
    *Group Reservation Rates are $3.50/youth and $5.00/adult*

29. Requested Area for Event:*
    -- Select One --Aquatic Level Party Room (20) (Features a private bathroom)Aquatic Level Studio (15) (Close proximity to the competition pool and locker rooms)Veranda (Located outside next to the Fun-For-All playground)

30. $195 Party Package Includes:

    2 hours of room rental, up to 15 admissions and swim time.

    Additional guests: Youth $3.50 and Adult $5.00

32. Date Requested*
33. Time Requested*
35. Alternate Date*
36. Alternate Time*

38. Schedule of Party Times:

    Saturday   or    Sunday
    1 PM - 3 PM
    or
    3:30 PM - 5:30 PM

40. I agree to indemnify and hold harmless the Town of Warrenton, its employees, and its agents from and against any and all liability for any injury which may be suffered in connection with this reservation. I also hold harmless the Town of Warrenton, its employees, and its agents from and against any liability for any equipment or supplies lost or damaged as a result of this reservation.

    I have read and agree to the attached Renter Responsibilities and Expectations, Facility Usage and Reservation Policies, and Pool Rules.

42. Renter Responsibilities and Expectations, Facility Usage and Reservation Policies, and Pool Rules
    Renter Responsibilities and Expectations etc (PDF)
44. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
46. Electronic Signature*
47. Date:*
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field