YMCA OF NEWARK AND VICINITY

Y On Wheels Request Form

Individual or Company Name
Renter Name
Phone
Email
Event Address
Emergency Name
Emergency Phone

Event Type
Start Date
End Date
Time of Event
Total Days of Rental
Is This An Ongoing Event?
 yes  no
 
Is parking available?
 Yes
 No
Number of People Expected
Event Primary Age Group
What activities are requested? (Check all that apply.)
 Basketball
 Soccer
 Street Hockey
 Team Games
 Miniature Golf
 Zumba
 Cardio
 Yoga
 Boot Camp
 African Dance
 Modern Dance
 Salsa Dance
 Jazz Dance
 Hip Hop for Health
 Nutrition Education (Go/Slow/Whoa Foods)
 My Power Plate
 Shakes or Smoothies
 Make My Own Snacks
 Planting Projects
 K'Nex Technology
 Table Top Games
 Rock Discovery
 Building Blocks
 Chess Masters
 Forensic Science
 Mad Scientist Kits
 Legos
 Carnival Games
 Face Painting
 Drumming
 Fun with Instruments
 Fun with Instruments
 Theater Games
Any Other Requirements?
×
×
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