Athletic Facility Reservation Request Form

2. GENERAL INFORMATION SECTION

4. First Name*

5. Last Name*

7. Date of Birth*
   Date of Birth

8. Gender

   1. Male

   1. Female

10. Mailing Address*

12. City*

13. State
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

14. Zip Code*

16. Email Address*

18. Phone Number*

19. Work Phone Number

20. Fax Number

22. Organization

24. Adult or Youth Activity*

    1. Adult
    2. Youth

25. Sport*

26. Number of expected participants and spectators*

28. Type of Activity*

    1. Clinic
    2. Game
    3. League
    4. Practice/Pickup
    5. Special Event
    6. Tournament

29. Do you have Liability Insurance?*

    1. Yes
    2. No

30. Are you fundraising?*

    1. Yes
    2. No

31. Are you charging admission*

    1. Yes
    2. No

33. Will there be vendors?*

    1. Yes
    2. No

34. Are you providing concessions?*

    1. Yes
    2. No

35. Do you have a Guilford County Health Department Permit for concessions?*

    1. Yes
    2. No
    3. N/A

37. Will you need power?*

    1. Yes
    2. No

38. Will you need lights?*

    1. Yes
    2. No

39. Will you need field preparation?*

    1. Yes
    2. No

41. Please explain your field preparation needs.*

    Field dimensions, number of fields, game lines, goals, etc.

45. LOCATION, DATE, & TIME SECTION
    Please be very detailed and include setup/breakdown time in your request

    Please be very detailed and include setup/breakdown time in your request

47. Location
    -- Select One --Allen Jay Field 1Allen Jay Field 2Allen Jay Field 3Armstrong Ball FieldBrentwood Field 1Brentwood Field 2Burnett Park Soccer FieldBurnett Park Ball Field 1Burnett Park Ball Field 2Cedrow Park Ball FieldDeep River Field 1Deep River Field 2Deep River Field 3Harvel Park Ball FieldHedgecock Park Ball FieldHP Athletic Complex - Correll MorrisHP Athletic Complex - Ed PriceHP Athletic Complex - Football FieldHP Athletic Complex - North 1HP Athletic Complex - North 2HP Athletic Complex - SouthHP Athletic Complex - TrackHP Athletic Complex - West 1HP Athletic Complex - West 2HP Athletic Complex - West 3HP Athletic Complex - West 4HP Athletic Complex - West 5Johnson Street Complex Field 1Johnson Street Complex Field 2Johnson Street Complex Field 3Johnson Street Complex Field 4Johnson Street Complex Field 5Johnson Street Complex Field 6Macedonia Ball FieldMorehead Field 1Morehead Field 2Oakview Upper Ball FieldOakview Lower Ball FieldOakview Multipurpose FieldWashington Terrace Football FieldWashington Terrace Softball FieldWest End Park Field 1West End Park Field 2West End Park Field 3

48. Date
    Date

49. Start and End Time
    Start and End Time Start Time

    —

    Start and End Time End Time

51. Location
    -- Select One --Allen Jay Field 1Allen Jay Field 2Allen Jay Field 3Armstrong Ball FieldBrentwood Field 1Brentwood Field 2Burnett Park Soccer FieldBurnett Park Ball Field 1Burnett Park Ball Field 2Cedrow Park Ball FieldDeep River Field 1Deep River Field 2Deep River Field 3Harvel Park Ball FieldHedgecock Park Ball FieldHP Athletic Complex - Correll MorrisHP Athletic Complex - Ed PriceHP Athletic Complex - Football FieldHP Athletic Complex - North 1HP Athletic Complex - North 2HP Athletic Complex - SouthHP Athletic Complex - TrackHP Athletic Complex - West 1HP Athletic Complex - West 2HP Athletic Complex - West 3HP Athletic Complex - West 4HP Athletic Complex - West 5Johnson Street Complex Field 1Johnson Street Complex Field 2Johnson Street Complex Field 3Johnson Street Complex Field 4Johnson Street Complex Field 5Johnson Street Complex Field 6Macedonia Ball FieldMorehead Field 1Morehead Field 2Oakview Upper Ball FieldOakview Lower Ball FieldOakview Multipurpose FieldWashington Terrace Football FieldWashington Terrace Softball FieldWest End Park Field 1West End Park Field 2West End Park Field 3

52. Date
    Date

53. Start and End Time
    Start and End Time Start Time

    —

    Start and End Time End Time

55. Location
    -- Select One --Allen Jay Field 1Allen Jay Field 2Allen Jay Field 3Armstrong Ball FieldBrentwood Field 1Brentwood Field 2Burnett Park Soccer FieldBurnett Park Ball Field 1Burnett Park Ball Field 2Cedrow Park Ball FieldDeep River Field 1Deep River Field 2Deep River Field 3Harvel Park Ball FieldHedgecock Park Ball FieldHP Athletic Complex - Correll MorrisHP Athletic Complex - Ed PriceHP Athletic Complex - Football FieldHP Athletic Complex - North 1HP Athletic Complex - North 2HP Athletic Complex - SouthHP Athletic Complex - TrackHP Athletic Complex - West 1HP Athletic Complex - West 2HP Athletic Complex - West 3HP Athletic Complex - West 4HP Athletic Complex - West 5Johnson Street Complex Field 1Johnson Street Complex Field 2Johnson Street Complex Field 3Johnson Street Complex Field 4Johnson Street Complex Field 5Johnson Street Complex Field 6Macedonia Ball FieldMorehead Field 1Morehead Field 2Oakview Upper Ball FieldOakview Lower Ball FieldOakview Multipurpose FieldWashington Terrace Football FieldWashington Terrace Softball FieldWest End Park Field 1West End Park Field 2West End Park Field 3

56. Date
    Date

57. Start and End Time
    Start and End Time Start Time

    —

    Start and End Time End Time

59. Location
    -- Select One --Allen Jay Field 1Allen Jay Field 2Allen Jay Field 3Armstrong Ball FieldBrentwood Field 1Brentwood Field 2Burnett Park Soccer FieldBurnett Park Ball Field 1Burnett Park Ball Field 2Cedrow Park Ball FieldDeep River Field 1Deep River Field 2Deep River Field 3Harvel Park Ball FieldHedgecock Park Ball FieldHP Athletic Complex - Correll MorrisHP Athletic Complex - Ed PriceHP Athletic Complex - Football FieldHP Athletic Complex - North 1HP Athletic Complex - North 2HP Athletic Complex - SouthHP Athletic Complex - TrackHP Athletic Complex - West 1HP Athletic Complex - West 2HP Athletic Complex - West 3HP Athletic Complex - West 4HP Athletic Complex - West 5Johnson Street Complex Field 1Johnson Street Complex Field 2Johnson Street Complex Field 3Johnson Street Complex Field 4Johnson Street Complex Field 5Johnson Street Complex Field 6Macedonia Ball FieldMorehead Field 1Morehead Field 2Oakview Upper Ball FieldOakview Lower Ball FieldOakview Multipurpose FieldWashington Terrace Football FieldWashington Terrace Softball FieldWest End Park Field 1West End Park Field 2West End Park Field 3

60. Date
    Date

61. Start and End Time
    Start and End Time Start Time

    —

    Start and End Time End Time

63. Location
    -- Select One --Allen Jay Field 1Allen Jay Field 2Allen Jay Field 3Armstrong Ball FieldBrentwood Field 1Brentwood Field 2Burnett Park Soccer FieldBurnett Park Ball Field 1Burnett Park Ball Field 2Cedrow Park Ball FieldDeep River Field 1Deep River Field 2Deep River Field 3Harvel Park Ball FieldHedgecock Park Ball FieldHP Athletic Complex - Correll MorrisHP Athletic Complex - Ed PriceHP Athletic Complex - Football FieldHP Athletic Complex - North 1HP Athletic Complex - North 2HP Athletic Complex - SouthHP Athletic Complex - TrackHP Athletic Complex - West 1HP Athletic Complex - West 2HP Athletic Complex - West 3HP Athletic Complex - West 4HP Athletic Complex - West 5Johnson Street Complex Field 1Johnson Street Complex Field 2Johnson Street Complex Field 3Johnson Street Complex Field 4Johnson Street Complex Field 5Johnson Street Complex Field 6Macedonia Ball FieldMorehead Field 1Morehead Field 2Oakview Upper Ball FieldOakview Lower Ball FieldOakview Multipurpose FieldWashington Terrace Football FieldWashington Terrace Softball FieldWest End Park Field 1West End Park Field 2West End Park Field 3

64. Date
    Date

65. Start and End Time
    Start and End Time Start Time

    —

    Start and End Time End Time

67. Do you have additional locations, dates and times?

    Please list any additional locations with the dates and times that you may need.

Leave This Blank:


69. 1. Receive an email copy of this form.
70. Email address

    This field is not part of the form submission.

71. Submit

* indicates a required field