Field Usage Request Form Field Use Application Applicant Name * Organization Name * What Season are You Applying for * Select SeasonSpringSummerFallWinter Organization Address* EIN Number (if applicable) On-site Contact Number * Name of Contact * Email Address* Field Requested (please check all that apply) Townly Field NorthTownley Field SouthTownley Baseball DiamondPee-Wee Park Baseball DiamondCentennial ParkMaggi ParkMahoney Park West 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) PracticeGame Do you require field lining? (fee applies) YesNo 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 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. Please leave this field empty.