Form Center

2. 

3. 
   

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

5. Name*
6. Date*
8. Organization or Group Name*
10. Address*
12. City*
13. State*
14. Zip*
16. Home Phone
17. Cell Number*
19. Email Address*
21. Event Description*
23. Number of Participants to Attend*
25. For Group Visits only: # of children 5 and under:
26. # of children 6 and older:
27. # of adults:
29. Requested Area for Event:*
    -- Select One --Aquatic Level Party Room (20)Aquatic Level Studio (15)Multi-purpose Room (75)Concourse TablesVerandaLap Lanes *Leisure Pool (see below for details)
30. If Lap Lanes *, # of lanes
31. Event Type:*
    -- Select One --MeetingWorkshopGroup Visit (10-50 people)Other
32. If other:
34. Date Requested*
35. Time Requested*
37. Alternate Date*
38. Alternate Time*

40. The following days of the week and times available for Leisure Pool Group Visits:

    Mon:  9 AM - 11 AM  |  11 AM - 1 PM  |  1 PM - 3 PM |   3 PM - 5 PM

    Tues:  -----------------  |  11 AM - 1 PM  |  1 PM - 3 PM |   3 PM - 5 PM

    Weds:  9 AM - 11 AM  |  11 AM - 1 PM  |  1 PM - 3 PM |   3 PM - 5 PM 

    Thurs:   --------------   |  11 AM - 1 PM  |  1 PM - 3 PM |   3 PM - 5 PM

    Fri:  9 AM - 11 AM  |  11 AM - 1 PM  |  1 PM - 3 PM |   3 PM - 5 PM

42. *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*

    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.

44. Renter Responsibilities and Expectations, Facility Usage and Reservation Policies, and Pool Rules
    Renter Responsibilities and Expectations etc (PDF)
46. 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.
48. Electronic Signature*
49. Date:*
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit

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