Athletic Field Use Request 2023

CONTACT INFORMATION

Organization Name	Necsl
Name of Activity / Event	---
Facility (See link to park locations and descriptions above)	---
Other (Write in N/A if not applicable) :	Concesión stand
Applicant Name/Contact Person	---
Email Address	---
Cell Phone	---
Day Phone	---
Billing Address	---
EIN/Tax #	---

EVENT INFORMATION

Name of Supervisor on Site	---
Supervisor Phone Number	+16177636735
Name of Second Supervisor on Site	---
Second Supervisor Phone Number	+16174180852
# of Teams in your Organization	---
# of Players in your Organization	---
Total Estimated Number of Participants	---
Organization Type	---
Activity	---
Sport (note: please use a separate form for each event)	Soccer
Brief Description of Activity	Soccer tournament
Please note any special requirements here	N/A

First preference for event date

Is this event happening on one date or multiple dates?

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First preference: Dates - Times - Facility

Dates (i.e. Every Sunday starting June 1 until September 1, from 10am-12pm)

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Second Preference: Dates - Times

If your first choice dates are not available, do you have a second choice?

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Second Preference: Multiple Dates

Dates (i.e. Every Sunday starting June 1 until September 1, from 10am-12pm)	---
Facility (See link to park locations and descriptions above)	---

Additional Questions

1. Will the event generate admission fee or revenue?	---
1a. If yes, please specify below (Write in N/A if not applicable):	---
2. Will amplification be utilized?	---
3. Will you provide any music or entertainment? If so, apply here: https://go.citygro.ws/the-department-of-licensing-permitting-and-consumer-affairs-chelsea-ma/sample-amusement-entertainment-license-7df35bdf-d54b-45e4-903d-990e2e5694f	---
4. Will there be any use of machinary powered by gasoline, diesel or electricity?	---
4a. If yes, please specify the usage (Write in N/A if not applicable):	---
5. Will food or beverage be provided?	---
5a. If yes, please specify (Write in N/A if not applicable)	---
5b. If food or beverage provided, will it be:	---
6. Will anything be sold at the event?	---
6a. If yes, specify (Write in N/A if not applicable)	---
7. Will you require lighting or access to electrical outlets?	---
8. Will you require use of restrooms, if available?	---

Indemnification/Hold Harmless

APPLICATION/ORGANIZATION shall indemnify, defend and hold the City and its agents, employees, and/or officers, harmless from and shall process and defend at it's own expense any and all claims, demands, suits at law or equity, actions, penalties, loss, damages, or cost , of whatsoever kind or nature brought against the CITY arising out of, or in connection with, or incident to, the execution of this rental application and/or the APPLICANT/ORGANIZATION'S performance or failure to perform any aspect of the Agreement, provided however, that if such claims are caused by the result from the concurrent negligence of the CITY, it's agents, employees, and/or officers, this indemnity provisions shall be valid and enforceable only to the extent of the negligence of the APPLICATION/ORGANIZATION; and provided further, that nothing herein shall require the APPLICATION/ORGANIZATION to hold harmless or defend the CITY, its agents, employees, and/or officers for damages or loss caused by the CITY'S sole negligence. the UNDERSIGNED has read and on behalf of the Licensee agrees to be bound by this permit/license and the Terms and Conditions contained herein and attached hereto my means of the Athletic Field Scheduling Guide Use and herby warrants and represents that he/she executed this permit/license request on behalf of the Licensee and has sufficient power, authority and capacity to bind the Licensee with his/her signature. Authorized Represenatative Electronic Signature:

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