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PARK FACILITY PERMIT APPLICATION <br /> 1. Name /Address/Phone Number of Individual or Organization responsible for <br /> making this application: <br /> Centennial Soccer Club / Chris Melmer Fields Director <br /> 612 - 616 -7082 <br /> 2. Please describe your event/activity and identify the specific facility /field within <br /> the park you wish to use along with what you are asking from the City: <br /> This is an ammendmant to the request approved for the use of LaMotte fields <br /> at the 4/4 board meeting. We would like to also use the Fields on Sundays <br /> during the soccer season (4/23 - 6 -30) from 4 -9 PM <br /> 3. What is the number of people that are involved in your event/activity? Varies <br /> 4. What City facilities do you wish to use <br /> Acorn Creek Park Eagle Park <br /> Laurie LaMotte Memorial Park Hidden Spring Park <br /> (Lighting & Warming House) Trailside Park <br /> Cornerstone Park Royal Meadows Park <br /> Tracie McBride Memorial Park City Hall <br /> 5. Please list the date or dates and times you propose to use the facilities: <br /> April 23 - June 30 from 5 - 9PM for practices. (see follow up document for detla <br /> 6. Is anyone charged a fee to watch or participate in your event? No <br /> 7. Have you used these facilities before? 0 If so, when? <br /> During the 2010 soccer season, and now approved for M -Th for 2012 <br /> 8. Are you requesting additional permits or City services? 111 Yes 0 No <br /> (i.e., Road Closure(s), Temporary Liquor License(s), Fireworks Permit or <br /> Burning Permit, Use of lights, bathrooms or . ports potties, Park Buildings) <br /> Please describe <br /> Depending upon the nature of your event, or if you are requesting City services, you may <br /> be required complete a different application and/or make a deposit to cover city costs. <br /> Chris Melmer 4/5/2012 <br /> Print:' N. IA o \ Person Signing Date <br /> +nI <br /> ignature <br /> Office Use Only <br /> Permit approved by: Date: <br /> Deposit required: $ Receipt # <br /> Form number: 2012.01 PU <br />