Field Usage Request Form

Applicant Name *

Organization Name *

What Season are You Applying for *

Organization Address*

EIN Number (if applicable)

On-site Contact Number *

Name of Contact *

Email Address*

Total Amount of Hours Requested

Type of Activity

Number of Participants

Participant Age Range

Emergency Contact Number

Emergency Contact Name

Applicant has reviewed the above information for accuracy and agrees to adhere to all regulations as listed in the Field Usage Policy, which is available on the Kenilworth Park District Website. Applicant agrees to the Field Usage Fee Chart. Applicant agrees to submit a certificate of liability insurance to the Kenilworth Park District prior to the season in which they are applying for.

Field Use Application

Field Requested (please check all that apply)

Dates and Times Requested (Input all dates and timeframes requested, i.e. Monday, June 3, 2019 5:30-7:30pm)

Type of Rental (please select one)

Do you require field lining? (fee applies)

If Yes, please indicate which dates you need field lining for (will be completed by Park District staff the day prior except for Sundays, in which the field will be lined on Friday)

Special Setup Requests