Public Schools Facilities Use 2024-2025

DIRECTOR/PRESIDENT/GROUP LEADER

Organization Name	---
Organization Type	Non Profit (501c3)
EIN/Tax #	33-2357698
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	64
Leader's Name	---
Leader's Phone Number	+18572011916
Brief Description of Event (please be as thorough as possible)	---
Space needed	---
Do you require equipment or setup?	---
Please specify what equipment you need/set-up	---

First Preference For Event Date/Time

Is this event happening on one date or multiple dates?

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First preference: Single Date

Date	2025-08-24
Day of the week	Sunday
Total Time requested (ex. 4:00pm-7:30pm)	---
Set-up Time (ex. 4:00pm-5:00pm)	---
Event Time (ex. 5:00pm-7:00pm)	---
Breakdown Time (ex. 7:00pm-7:30pm)	5:00pm-6:00pm

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?	Yes
Please explain, what kind of food, how will it stored, will it be homecooked or store bought, etc.	Food by Chelsea’s own Calixto David serving authentic Puerto Rican cuisine already pre cooked by a chef and brought to the school or park.

Food Waiver

Name of Director/President/Group Leader:	---
Date	2025-08-01
I understand that I am completing a binding electronic signature when I submit this form constitutes a legal signature.	Yes

Indemnification/Hold Harmless

Name of Director/President/Group Leader:	---
Date	2025-08-01
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	2025-08-01
I understand that I am completing a binding electronic signature when I submit this form constitutes a legal signature.	Yes