City of Galesburg Parks & Recreation - Hawthorne Gym: Waiver/Request Form

Gym Rental Request and Waiver*

Please review the waiver and rules listed below for your Hawthorne Gym Rental request.

This waiver must be completed a minimum of two weeks prior to your rental time. Booking is dependent upon staff availability when request is made later than the 15th of the month before.

Your request is not guaranteed until you have been contacted by Recreation Staff. Payment must be made upon confirmation of booking and rentals not paid by 10 days before your event date will be cancelled.

Recreation Office: 309-345-3685
Email: recinfo@ci.galesburg.il.us
Mail: City of Galesburg, ATT: Recreation, PO Box 1387, Galesburg IL 61402
Walk in: 1033 S. Lake Storey Rd, Galesburg IL 61401

First name *

Last name *

Email *

Mobile *

Address *

City *

Country *

State/Province *

Zip/Postal code *

HAWTHORNE GYMNASIUM RULES AND REGULATIONS:

1.) No food or drinks are allowed on the gym floor. All food and drinks must be contained on the concrete sidelines. No alcohol or drugs allowed on City of Galesburg property.
2.) No rough items are allowed on the gym floor. This includes, but is not limited to: chairs, tables, and cleats. On site staff persons are able to determine additional items that will not be allowed.
3.) Bounce Houses are not allowed.
4.) All guests must be respectful of the facility. This includes following any rules, listening to onsite staff members, picking up after any messes made, and behaving in a safe manner.
5.) All rental times include your set up and tear down. The facility must be cleaned promptly by the end of your event. Your rental time request includes the entire time you need the facility, including decorating/bringing in supplies for your event and removal of your belongings at the end of your event. Time extensions at the time of event are not allowed, so please plan accordingly
6.) No items may be left behind at the facility—any items that are brought into the facility must also be removed from the facility by the end of the rental time period.

Date requested *

Start Time of Rental (including setup time) *

+ Add

End Time of Rental *

+ Add

Number of hours requested (includes all time in facility)

If multiple dates requested, please list dates and contact Recreation Supervisor

Reservations for *

Select all Clear all

Birthday Party Athletic Event Social Event Other

If answered other, describe your event.

Gym setup requested: *

Select all Clear all

Basketball/Empty Gym Other(contact office) Pickleball net Requesting basketballs Requesting dodgeballs Requesting pickleballs and paddles Requesting volleyballs Scoreboard (team rentals) Volleyball Net

If answered other, describe your event.

2026: Gym Rental Fee is $50 per hour. Certain equipment requests or need for additional staff may be an additional fee.

Estimated number of attendees *

Age group of most guests *

Will there outside equipment at your event *

Yes No

If yes, describe

Will there be food/drinks at your event *

Yes No

If yes, describe

RENTAL AGREEMENT

It is hereby understood that the undersigned application will arrive at opening time, remain until closing time, be completely responsible for the proper conduct of the group, and leave the building in a clean manner. The rental time includes ALL TIME in the facility. (Set up, tear down, present/cake time, and whatever else may be planned)

Cancellations must be communicated to the office no later than 24 hours prior. This communication must be done during business hours. (If an event is on Sunday and needs to be cancelled the office would need notification by the preceding Friday by 5:00pm). Refunds for advance cancellations will be for full amount paid minus 10% administrative fee.

I agree to waive and relinquish all claims my party or I may have as a result of renting a facility and participating, against the City of Galesburg and their officers, agents, servants, and employees. I do hereby fully release and discharge the City of Galesburg and their officers, agents, servants, and employees from any and all claims from injuries, damage or loss, which may have accrued to our rental party and arising out of, connected with, or in anyway, associated with the activities of the rental party.

If damages occur to the facility or equipment I understand that I may be charged for repairs or replacements. I agree to allow photos to be taken, and used, by the City of Galesburg for marketing purposes.

I have read and accept *

Todays Date:

Signature of Application*

Please sign your name inside the box