Fillable Atherton Ymca Housing Application Form (Page 2 of 3) in pdf

ATHERTON YMCA HOUSING APPLICATION FORM

Indicate Any Special Needs/Requests In The Space Below:

Roommate Preference (If Applicable)

Parking Request (Optional)

Covered Parking

Uncovered Parking

(Under Mary Atherton Richards House)

(Behind Charles H. Atherton House)

How Did You First Hear About Atherton?

Other:

Agreement to Terms and Conditions

I understand and agree to the terms and conditions contained in the Atherton Housing Handbook. I agree to

observe all rules and regulations of the Atherton Branch YMCA. I understand and agree to the following:

1. This agreement is not transferable.

2. In order for this application to be valid, a payment of $235.00 must be received.

($200 Deposit + $35 Processing Fee)

3. I am responsible to meet all payment terms laid out in the Atherton YMCA Housing Contract & Handbook

issued to me.

4. I must be a registered student (or an official visiting scholar) at an accredited Hawaii College or University.

5. If I fail to comply with any terms of my Housing Contract and Handbook the YMCA has the right to cancel this

agreement and evict me.

6. The YMCA is a drug & alcohol free community. Residents are expected to follow the YMCA four core values of

Respect, Responsibility, Honesty and Caring. Failure to abide by these guidelines could result in immediate

cancellation of this agreement and eviction.

7. I understand that I will be financially responsible for rent and cancellation penalties should I terminate this

Housing agreement.

By initialing here, I understand Atherton YMCA will keep 50% ($100) of the deposit fee in the event I cancel

this contract outside of 30 days from the contract start date. In addition, the full deposit ($200) will be retained

should I cancel within 30 days of the contract start date.

By checking this box, I give the Atherton YMCA permission to release my name and address information to

my assigned roommate.

By initialing here, I understand that applications will be processed in the order they are received. Current

residents will receive priority over first time residents during the application process. Applications received mid

semester will take a minimum of 24 hours to be processed and residents will not be able to move in until the full

rental deposit and a signed contract are received.

8. I certify that all the information on this application is true and accurate; I understand that giving false

information may disqualify my application.

SIGNED_______________________________________________________Date__________________________

(Signature of Parent or Guardian if applicant is under 18 years of age)

ATHERTON YMCA | 1810 UNIVERTSITY AVE, HONOLULU, HI, 96822 | P (808) 946-0253 F (808) 955-0893

Atherton Ymca Housing Application Form Page 2