Athletic Field Use Request 2023

CONTACT INFORMATION

Organization Name	Torneo Independencia
Name of Activity / Event	---
Location (See link to park locations and descriptions above)	---
Other (Write in N/A if not applicable) :	Na
Applicant Name/Contact Person	---
Email Address	---
Cell Phone	---
Billing Address	---

EVENT INFORMATION

Name of Supervisor on Site	---
Supervisor Phone Number	+18572375905
Name of Second Supervisor on Site	---
Second Supervisor Phone Number	+18572375905
# of Teams in your Organization	---
# of Players in your Organization	---
Total number of people expected	---
Organization Type	---
Activity	---
Brief Description of Activity	A tournament that we have been doing for fun for over 10 years now.
Primary Participants?	Adults
Sport (note: please fill out a separate application for each event)	Soccer
Please note any special requirements here	None this activity if for fun bring the community together

First preference for event date

Is this event happening on one date or multiple dates?

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First preference: One Date

Date	2023-09-17
Day of the week	Sunday
Total Time requested (ex. 4:00pm-7:30pm)	---
Set-up Time (ex. 4:00pm-5:00pm)	---
Total Event Time (ex. 5:00pm-7:00pm)	---
Breakdown Time (ex. 7:00pm-7:30pm)	---

Second Preference?

If your first choice date is not available, do you have a second choice?

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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

Name of Director/President/Group Leader:	---
Date	2023-09-15
I understand that I am completing a binding electronic signature when I submit this form constitutes a legal signature.	Yes

Policy Acknowledgement/Acuse de recibo

Name of Director/President/Group Leader:	Jose vigil
Date	2023-09-15
I understand that I am completing a binding electronic signature when I submit this form constitutes a legal signature.	Yes