Athletic Field Use Request 2023

CONTACT INFORMATION

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

EVENT INFORMATION

Name of Supervisor on Site	---
Supervisor Phone Number	+12672059502
Name of Second Supervisor on Site	---
Second Supervisor Phone Number	+17817991771
# of Teams in your Organization	---
# of Players in your Organization	---
Total number of people expected	---
Organization Type	---
Activity	---
Brief Description of Activity	Requesting this field on behalf of Soccer Shots Boston, a youth soccer enrichment program whose goal is to deliver an engaging soccer program to children ages 2-8 with a focus on education and character development. We seek to teach kids foundational soccer skills in a fun, unique, and engaging way. We are relatively new to the Boston area and are seeking to expand our programming into the Chelsea community to positively impact the lives of the families that reside there. For more information, here is a link to our website: https://www.soccershots.com/boston/
Primary Participants?	Youth
Sport (note: please fill out a separate application for each event)	Soccer
Please note any special requirements here	Do not need full soccer field space. As we are a youth enrichment program, we only require a small, grassy area about the size of half a tennis court.

First preference for event date

Is this event happening on one date or multiple dates?

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First Preference: Seasonal

Dates	---
Days of the week	---
Times	4:30PM - 6:00PM

Second Preference?

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

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Second Preference information

Days of the week	Tuesday, Thursday
Dates	All Tuesdays from 04/23 - 06/ 11 or all Thursdays from 04/25 - 06/13
Times	4:30PM - 6:00PM
Location	Washington Park

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?	---
9. Please list any additional Special Requirements	---

Indemnification/Hold Harmless

Name of Director/President/Group Leader:	---
Date	2024-02-29
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:	Brendan Lash
Date	2024-02-29
I understand that I am completing a binding electronic signature when I submit this form constitutes a legal signature.	Yes