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

Contact Person

Name/Last Name	---
Phone	---
Email Address	---
School	Browne Middle School

EVENT INFORMATION

Event/Activity Name	---
Leader's Name	---
Leader's Phone Number	+17812154206
Brief Description of Event	---
School Building	---
Facility	---
Total Estimated Number of Participants	60
Do you require special equipment or setup?	---

Additional Questions

Will food be served?

No

First Preference For Event Date

Is this event happening on one date or multiple dates?

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First preference: Two or More Dates - Times

Dates (i.e. Every Sunday starting June 1 until September 1, from 10am-12pm)

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Second Choice Interest: Two or More Dates

If your first choice dates are not available, do you have a second choice?

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Second Preference: Multiple Dates

Dates (i.e. Every Sunday starting June 1 until September 1, from 10am-12pm)	---
Facility (See link to park locations and descriptions above)	---

Attachments

Please upload any attachments (proposed site plan)

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