TOWN OF NORTHBRIDGE

PLAYGROUND & RECREATION COMMISSION

 

Field Request (please complete 1 form for each field requested)

 

Requesting Organization:

 

Contact Name:

 

Contact Phone Number:

 

Contact Email Address:

 

Requested Field (one field per form, please):

 

Dates/Days Requested:

 

Times Requested:

 

Non-Profit Organization (please indicate Yes or No):

 

For organizations that used Town field space during their previous season, please provide the following information:

 

Total Number of Participants:

 

Number of Town Residents:                        Number of non-Residents:

 

Additional details, if any:

 

 

 

Approved by the following PRC commissioners:

 

Printed Name

Signature

Date

 

 

 

 

 

 

 

 

 

 

Prior to field use, PRC must receive a signed Participation Consent Form (found at www.northbridgemass.org/parkrec ) for each participant along with the respective field usage fee, as noted below.

Northbridge Residents:  $10 per person

Non- Residents:             $15 per person