Chelsea Recreation & Cultural Affairs

*CPS INTERNAL USE ONLY - Browne, Wright & Clark Schools Facility Request

Nov 09, 2023
submission #117
Reservation Form

Contact Person

Name/Last Name ---
Phone ---
Cell Phone ---
Email Address ---
School Clark Avenue Middle School

EVENT INFORMATION

Event/Activity Name ---
Leader's Name ---
Leader's Phone Number +16174665100
Brief Description of Event (please be as thorough as possible) ---
Total Estimated Number of Participants 200
School Clark Avenue Middle School
Space Needed ---
Do you require equipment or setup? ---
Will food be served? No

First Preference For Event Date

Is this event happening on one date or multiple dates? ---

First preference: Single Date

Date 2023-11-14
Total Time Needed (i.e. 2-6pm) ---
Set-up Time (i.e.2-3pm) ---
Event Time (i.e. 3-5:30pm) ---
Breakdown Time (i.e. 5:30-6pm) 5:30-6pm

Second Preference?

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