Skip to content
We Love to Uplift | WLTU | Haiti | Chicago, IL | Dallas, Texas
Create Opportunities For Success
Rental Request Form
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
LESSEE INFORMATION
Name
*
Address:
*
Telephone Number:
*
Name and Title of Authorized Signatory (If Leasee is a Legal Entity)
*
Event Information
Location
*
Event Location:
*
13838 S. Croissant Drive, Burnham, Illnois 60633
13900-13926 S. Croissant Drive, Burnham, Illinois 60633
13926 S. Croissant Drive, Burnham, Illinois 60633
Start Date / Time of The Event
*
Date
Time
End Date / Time of the event
*
Date
Time
Number of Guests
*
Purpose of the Event
*
Name of Bride and Groom (if event is a wedding)
INSURANCE INFORMATION
Lessor’s Renter’s Insurance Application Form Required
*
Yes
No
Age Group of Guests/Attendees
*
Minors (17 or younger)
18 – 24
25 – 35
35+
Check all that apply
*
Liquor/Alcohol Served
Liquor/Alcohol Sold
Water Activities
Amusement Devices/Inflatables
Rides
Camping/Sleeping Overnight
Have you or anyone involved in the Event had more than 1 Event Liability Claims/Losses or any Event Liability Claim/loss valued over $10,000 in the past 5 years?
*
Yes
No
Please provide details if you said yes to the Event Liability Claim above
*
Is there a Famous Person attending the event
*
If so, what is their name?
Will there be live music?
*
Yes
No
Submit