Room Rental Request Form Room Rental Request Form – Providence Care Hospital You will be contacted with confirmation of the room booking, subject to availability. Applicant Information:Name:* Name of Organization:* Address: City: Phone Number:* Email Address:* Event Information:Name of Event:* Date of Event:* MM slash DD slash YYYY Start Time:* : Hours Minutes AM PM AM/PM End Time:* : Hours Minutes AM PM AM/PM Type of Event/Description:* Number of Attendees:*Is your event exclusive to Providence Care attendees?* YES NO Describe who is invited to attend the event:*Registered Not-For-Profit Group:* YES NO Registration Number: Room: Founders’ Hall Classroom A Classroom B Combined Classroom A & B Classroom C Classroom D Admin A Meeting Room Computer Training Room Group Room (Large) Private Dining Room/Meeting Room Gymnasium Pool Vendor Display Area Additional Details:* Applicant’s Acknowledgement:* I certify that I have read the Providence Care Agreement and agree to abide by such terms. Δ