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Photostrip collage of Physical Education Classes and Hearst Gym

Hearst Gym Facility Rental Request and Event Plan Form

Contact Name


Email Address


Event Name


Facility To Rent


Contact Phone 1


Contact Phone 2


Best Time to Call


Hosting Group


Date - 1st Choice (mm/dd/yyyy)


Date - 2nd Choice (mm/dd/yyyy)


Is this a recurring event?

If it is a recurring event please describe the recurrence


Estimated Attendance


Time Requested
Set-Up Start Time: End Time:
Event Start Time: End Time:
Take Down Start Time: End Time:

Please Check either "Yes" or "No" on all of the following questions. Are you..
Charging admission? How much?
Providing Food?
Selling Food?
Serving alcohol?
Bringing in vendors? Name of vendor
Advertising? How?
Is this event sponsored? By whom?
Is this a fundraiser? Benefiting?

Description of Event


Additional Comments