Public Schools Facilities Use 2024-2025

DIRECTOR/PRESIDENT/GROUP LEADER

Organization Name	---
Organization Type	Internal (City Hall, Chelsea Public Schools)
Contact Person	---
Address	---
Cell Phone	---
Email Address	---
Additional contact person	---
Cell phone number of additional person	---

EVENT INFORMATION

Event/Activity Name	---
Primary Participants	Youth , Adults
Total Estimated Number of Participants	35
Leader's Name	---
Leader's Phone Number	+16175297356
Brief Description of Event (please be as thorough as possible)	---
School	---
Space needed	---
Do you require equipment or setup?	---

First Preference For Event Date/Time

Is this event happening on one date or multiple dates?

---

First preference: Seasonal

Dates	2024-11-07 - 2025-02-20
Days of the week	Monday, Tuesday, Wednesday, Thursday
Times	4:30 - 6:30 or any time after

Second Preference?

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

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Additional Questions

Will food be served?

No

Indemnification/Hold Harmless

Name of Director/President/Group Leader:	---
Date	2024-11-05
I understand that I am completing a binding electronic signature when I submit this form constitutes a legal signature.	---

Rules and Regulations

Name of Director/President/Group Leader:	---
Date	2024-11-05
I understand that I am completing a binding electronic signature when I submit this form constitutes a legal signature.	Yes