60612 PROGRAM INQUIRY FORM!

Thank you for your interest in the 60612 program! This program allows residents who live in the 60612 zip code to take advantage of Fifth Third Arena space and ice rentals, youth and adult hockey programs, and drop in public programing for free! (All grants, discounts, and free program offerings are reserved for families with a combined household income of $75,000/year or less). Along with the submission of this form please create a DaySmart account in order to move forward with bookings and reservations.

Contact Name

Phone

Do you reside in the 60612 Zip code?

Yes

I do not but my organization does

Name of Group

Date(s) of Visit

Type of Request

Program Interest

Number of People

Comments/Requests

CREATE A DAYSMART ACCOUNT