DEPARTMENT OF ATHLETICS
ALUMNI FIELD/LEICESTER/WORCESTER GYMNASIUMS/TENNIS COURTS
FACILITY REQUEST FORM

Organization Name (required)             

Today's Date:
On-Campus Group
Off-Campus Group

Contact Person (Required):          

Contact Phone Number (Required):

Room Number/Street Address:            

Box Number/City, State:

Contact Email (Required):

Date of Request (1st Choice):     Time Requested:
                                                                                                                  From-To
Date if Request (2nd Choice):     Time Requested:
                                                                                                                  From-To

Is your program profit or non profit: Profit   Non-Profit

Number of Participants:           Number of Spectators:

Ratio of adults to youth participants:

Name of peron who will be on-site during the event:

                               Night Phone:

                               Day Phone:
                              
                               Cell Phone:

Name of your on-site medical person (Certified Trainer, EMT, etc.):

                                                                                           Phone:

Is there a fee charged to participants or teams?
                                                If yes, how much?
  
Will there be an admission Charge?          If yes, How much?

Will there be food, concessions, etc?

Facility Requested
Alumni Field
Leicester Gym
Worcester Gym
Tennis Courts