PLAYGROUND & RECREATION COMMISSION
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):
BOH approval is required if an activity meets at least three times over
a two week period.
Board of
Health of Approval:
(Signature of BOH
representative)
Additional details, if any:
Approved
by the following PRC commissioners:
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Signature |
Date |
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Prior to field
use, PRC must receive a signed Participation Consent Form (found at www.northbridgemass.org/parkrec ) for each participant
along with the camp fee of $150. An
insurance binder must also be provided to PRC.