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2. This form acts as an application only. Completion of this application does not automatically guarantee requested date/time.
4. Contact Person Name*
   Contact Person will be responsible for relaying all information including the VANDALIA RECREATION CENTER RULES AND REGULATIONS to their group as well as confirming all administrative details and payment with the Recreation Coordinator.
5. Contact Person Birthdate*
   Contact Person Birthdate
7. Contact Person for the Day of Outing*
   This person will be the onsite contact person the day of the outing who will ensure that all of the VANDALIA RECREATION CENTER RULES AND REGULATIONS are followed.
9. Organization / Group Name*
11. Approximate Number of Guests*
13. Approximate Age Range of Guests*
15. Address*
17. City*
18. State*
19. Zip Code*
21. Primary Phone Number*
22. Alternate Phone Number
24. Email*
26. Date Requested*
    Date Requested
28. Time Requested*
    Time Requested
30. Options
    Please mark the area(s) in which you would like to receive group pricing. You must have at least 10 people to receive a group rate. These rates are only available during regular Rec Center operating hours and you would share these areas with Members and the public.
32. Special Requests
34. Check all that Apply*

    1. Aquatics Center - $4.00 per Resident/Community Group; $6 per Non-Resident
    2. Luther's Jungle Indoor Playground - $2.00 per Child - Parent/Guardian signed Waiver REQUIRED
36. If you are interested in renting a specific area or want to utilize the Rec Center during non-operating hours, please fill out the Rental Request Form and refer to the Facility/Area Specific Rental Pricing.
38. Vandalia Recreation Center Rules and Regulations
    Vandalia Recreation Center Rules and Regulations
40. Electronic Signature*
    By signing your name here you acknowledge that you have read and fully understand the VANDALIA RECREATION CENTER RULES AND REGULATIONS . Completion of this application does not guarantee requested date/time.
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field