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*

First Last

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Physical Address*

Street Address Address Line 2 City State ZIP Code

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

Animals*

Animals: Only authorized animals are allowed on the property of Island of Hawaii YMCA.*

Alcohol/Drugs*

Alcohol, Drugs, Tobacco: Alcohol and drugs of any kind are NOT allowed on Island of Hawaii YMCA property. We ask that you do not promote any host, non-host bars or BYOB of alcohol on your invitations, fliers, social media marketing/advertising. Island of Hawaii YMCA also a non-smoking property. Please ensure that your guests are aware of our property rules and respect it all times. Your deposit will not be refunded to you, should we find evidence of alcohol, drugs or tobacco on the property.*

Certified Kitchen*

Certified Kitchen: If the use of our certified kitchen service is to prepare and/or cook for commercial or fundraising purposes, you must schedule and work with the State of Hawaii Department of Health in obtaining the State of Hawaii Department of Health-Food Safety Program Green inspection placard. Hawaii Administrative Rules Section 11-50-9 (b). We also request Kitchen rental food handlers for your event to observe the Kitchen Guidelines posted in our certification and enclosed with our agreement. Visit www.health.hawaii.gov for more information regarding How to get a Green Placard.*

Clean-up*

Clean-up: The applicant is responsible for the cleanup of the rented. Utilize the clean-up checklist to ensure all items on the checklist are completed and the hall and/or kitchen is returned to the same condition as it was prior to the event. Cleaning supplies will not be supplied by Island of Hawaii YMCA. The upper, lower and back gravel parking is also an area of responsibility of the applicant to clean and ensure that all debris are removed. Filled trash bags must be placed in the trash container located on the vacant lot. Our trash container is not able to accommodate a large load of trash. Please see clean up checklist given to you upon the walk-through visit. For Kitchen Use, please utilize the 3- Compartment Sink Manual cleaning and Sanitizing of Food Equipment & Utensils.*

Insurance*

Event Liability Insurance: Event liability insurance may help cover expenses if you are found responsible for property damage or an injury caused during your celebration. Event liability insurance may help pay to repair damage to the venue or cover a guest's medical bills if you are found at fault. Seek for insurance options with insurance companies. Provide Island of Hawaii YMCA with your event liability insurance letter/certificate by the time of the walk-through appointment (no later than 15 business days of the event). Please report any damages or incidents to management.*

Proof of Liability Insurance

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

Special Event Food Establishment Permit Holders*

For SPECIAL EVENT FOOD ESTABLISHMENT PERMIT HOLDERS ONLY: ALL DATES SHALL BE listed on application (not to exceed 31 dates). Payment shall be collected in full for use of kitchen. Payment schedule to be completed by office staff.*

Walk Through*

Walk through: A required walk-through of the facility must be arranged with a YMCA staff prior to initial visit or use of kitchen*

Refunds & Rescheduling*

Refunds & Rescheduling: 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.*

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