Kitchen Rental Application – Island of Hawaii YMCA

Certified Kitchen Co-Op Application

"*" indicates required fields

Fee Schedule

$50.00 General YMCA Membership (one-time only)
$50.00 Authorized Signature for Department of Health Support Kitchen Use Agreement (YMCA CEO)
$25.00 / hour Wastewater Disposal Fee
$15.00 / per hour Kitchen Preparation
$20.00 / per hour Kitchen Appliances (usage of Oven, Stove, Refrigeration, Electricity)
GREEN PERMIT HOLDERS ONLY: $50.00 per month for non-use of kitchen will be charged to keep permit active at YMCA (automatic billing on a credit or debit card must be in place). No payment, will result in cancellation of permit with the YMCA and the Dept. of Health will be informed of cancellation.

The YMCA will make no refunds or reschedule once kitchen rental fees are paid for the month(s) even if the kitchen was partially used or not used at all.

Are you a YMCA Member?*

You must be a YMCA member to reserve the kitchen facility.

Yes

Please register for YMCA Membership

You have indicated you are not currently a YMCA member. Membership is a one-time $50 fee for lifetime. Membership covers 2 adults and any children in a shared household. Please sign up for a YMCA membership online and then complete your kitchen application.

Business Name*

Applicant Name*

Mailing Address*

Physical Address*

Email*

Phone*

Food Handler Certification Card*

Accepted file types: jpg, pdf, png, webp, Max. file size: 5 MB.

Photo ID*

Accepted file types: jpg, pdf, png, webp, Max. file size: 5 MB.

Food Product*

Location of Distribution*

Distribution Dates*

Referred By

Purpose for Rental*

Dept. of Health Agent Contact Name

Agent Phone

Business Type*

Non-Profit

Profit

Other

Food Truck*

Yes

Food Truck Location

Requested Certified Kitchen Co-Op Dates*

Date

Day

Start Time

End Time

Purpose

Kitchen Use or Wastewater Disposal?

General Rules & Consent

Proof of Liability Insurance

Accepted file types: pdf, png, jpg, webp, Max. file size: 5 MB.

The collection of the certified Kitchen Co-Op rental application & agreement final approval will be approved by the Island of Hawaii YMCA management and/or CEO. The payment schedule is to be completed by office staff.

Form submission disabled - Please register for YMCA Membership

You have indicated you are not currently a YMCA member. Please sign up for a YMCA membership online and then complete your kitchen application, make sure to indicate "Yes" that you are a member at the top of this form.

Hawaii Dept. of Health Food Safety and Sanitation Guidelines

You must observe appropriate food safety and sanitation methods while using the YMCA certified kitchen. Please review the Dept. of Health reference sheet here.

Food Safety & Sanitation

Dept. of Health Permit Applications, Forms & Guidelines