Commnity Paper

Topics: Insurance Pages: 4 (846 words) Published: November 9, 2011
PRINCE WILLIAM COUNTY PARK AUTHORITY
APPLICATION FOR COMMUNITY USE OF PARK AND SCHOOL FACILITIES

All information must be furnished before this application can be processed. All fees are due before the permit is issued. Scheduling and obtaining approvals of requested facility use may require 15 to 30 working days to complete. PLEASE PRINT OR TYPE APPLICATION FORM - Please provide complete and accurate information| School or Park Site Requested: Mayhew Park or Ben Lomond Park (or similar)| Type of Field Football/Soccer or Facility Requested (circle facility if requested): Gymnasium Auxiliary Gym Auditorium Cafeteria Kitchen Classroom Other: __________Special Equipment Required:None______________________________________________| Type of Activity planned: Flag Football tournament|

Days of Week: Mn Tu Wd Th Fr Sa Su (Circle Days which apply)| Start Date__11__/__26__/__2011__ End Date__11__/__26__/___2011_(one day tournament) (alternate dates: 11/27/11 or 12/3/11)Use separate sheet if necessary| Start Time__9AM____ End Time__4PM____| Your Name: Kenneth Monh|

Your Address: 9214 Campfire ct Bristow VA 20136| Your Home Phone: (703) 331 - 0396 Work Phone Ex: Fax: ( ) - Cell Phone: (703) 332 - 1846 | Your E-Mail Address: Kmonh12@gmail.com|

Name of Organization: Virginia Laos Sport Association |
Organization Address:195 Heather Glen Rd. Potomac VA 20165| Expected Number of Participants: 80 Number of Chaperons: (all participants over 18 yrs old)Do you/does your organization collect fees, dues, admission for this activity? Yes No If "yes," what type: Team registration fee amount: When/how often? | Do you/does your organization...
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