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2. Informal Field Use Request

   INFORMAL FIELD USE is any scheduled use for nine (9) or less specific dates. May be requesting time for a practice, game, sports camp, non-sporting event, etc. For more information, refer to the Field Scheduling Guide or email Scott Purdy, Park Operations Manager (scott.purdy@bothellwa.gov).

6. Organization/Group Name*
7. Participants*

   1. Youth
   2. Adults
9. Contact Name (First and Last)*

   This person will be the single point-of-contact with the City of Bothell throughout the reservation process.

11. Address*
13. City*
14. State*
15. Zip Code*
17. Phone Number*
18. Email*
22. FIELD REQUEST INFORMATION

    Please submit a new request for each change in location OR field use (ex: one request for North Creek Sportsfield practices, one for North Creek Sportsfield games, one for Doug Allen practices, etc.). A SUBMITTED REQUEST FORM DOES NOT GUARANTEE THE AVAILABILITY OF REQUESTED FIELDS OR DATES/TIMES.

24. FIELD REQUEST #1
26. Field(s) (check all that apply:)*

    1. North Creek #1 (synthetic)
    2. North Creek #2 (synthetic)
    3. North Creek #3 (grass)
    4. North Creek #4 (synthetic)
    5. Doug Allen #1 (grass)

    1. Doug Allen #2 (grass)
    2. Doug Allen #3 (grass)
    3. Doug Allen #4 (grass)
    4. Cedar Grove (grass)
27. Day(s) of week (check all that apply):*

    1. Sunday
    2. Monday
    3. Tuesday
    4. Wednesday

    1. Thursday
    2. Friday
    3. Saturday
29. Dates requested (start-finish):*
    Dates requested (start-finish): Start Date

    —

    Dates requested (start-finish): End Date
30. Times requested (start-finish):*
    Times requested (start-finish): Start Time

    —

    Times requested (start-finish): End Time
32. Additional comments (opt):

    Please list preferred field(s), preferred night(s) of the week, any dates not needed in the range, etc.

34. Activity type:*

    1. Game
    2. Practice
    3. Other
35. Sport:*

    1. Soccer
    2. Slow Pitch
    3. Baseball
    4. Fast Pitch
    5. Lacrosse
    6. Football
    7. Other (please specify)
36. Other:
38. Max # participants using a field at one time:
40. Field prep (check all that apply):*

    1. 60' bases
    2. 65' bases
    3. 40' pitching rubber
    4. 46' pitching rubber

    1. 50' pitching rubber
    2. Soccer goals
    3. Other
    4. No prep required
41. Other prep: (Subject to availability. Additional fees may apply.)
43. FIELD REQUEST #2
45. Field(s) (check all that apply)

    1. North Creek #1 (synthetic)
    2. North Creek #2 (synthetic)
    3. North Creek #3 (grass)
    4. North Creek #4 (synthetic)
    5. Doug Allen #1 (grass)

    1. Doug Allen #2 (grass)
    2. Doug Allen #3 (grass)
    3. Doug Allen #4 (grass)
    4. Cedar Grove (grass)
46. Day(s) of week (check all that apply):

    1. Sunday
    2. Monday
    3. Tuesday
    4. Wednesday

    1. Thursday
    2. Friday
    3. Saturday
48. Dates requested (start-finish):
    Dates requested (start-finish): Start Date

    —

    Dates requested (start-finish): End Date
49. Times requested (start-finish):
    Times requested (start-finish): Start Time

    —

    Times requested (start-finish): End Time
51. Additional comments (opt):

    Please list preferred field(s), preferred night(s) of the week, any dates not needed in the range, etc.

53. Activity type:

    1. Game
    2. Practice
    3. Other
54. Sport:

    1. Soccer
    2. Slow pitch
    3. Baseball
    4. Fast pitch
    5. Lacrosse
    6. Football
    7. Other (please specify)
55. Other:
57. Max # participants using a field at one time:
59. Field prep (check all that apply):

    1. 60' bases
    2. 65' bases
    3. 40' pitching rubber
    4. 46' pitching rubber

    1. 50' pitching rubber
    2. Soccer goals
    3. Other
    4. No prep required
60. Other prep: (Subject to availability. Additional fees may apply.)
62. FIELD REQUEST #3
64. Field(s) (check all that apply):

    1. North Creek #1 (synthetic)
    2. North Creek #2 (synthetic)
    3. North Creek #3 (grass)
    4. North Creek #4 (synthetic)
    5. Doug Allen #1 (grass)

    1. Doug Allen #2 (grass)
    2. Doug Allen #3 (grass)
    3. Doug Allen #4 (grass)
    4. Cedar Grove (grass)
65. Day(s) of week (check all that apply):

    1. Sunday
    2. Monday
    3. Tuesday
    4. Wednesday

    1. Thursday
    2. Friday
    3. Saturday
67. Dates requested (start-finish):
    Dates requested (start-finish): Start Date

    —

    Dates requested (start-finish): End Date
68. Times requested (start-finish):
    Times requested (start-finish): Start Time

    —

    Times requested (start-finish): End Time
70. Additional comments (opt.):

    Please list preferred field(s), preferred night(s) of the week, any dates not needed in the range, etc.

72. Activity type:

    1. Game
    2. Practice
    3. Other
73. Sport:

    1. Soccer
    2. Slow pitch
    3. Baseball
    4. Fast pitch
    5. Lacrosse
    6. Football
    7. Other (please specify)
74. Other:
76. Max # participants using a field at one time:
78. Field prep (check all that apply):

    1. 60' bases
    2. 65' bases
    3. 40' pitching rubber
    4. 46' pitching rubber

    1. 50' pitching rubber
    2. Soccer goals
    3. Other
    4. No prep required
79. Other prep: (Subject to availability. Additional fees may apply.)
83. ORGANIZATION AUTHORITY*

    In the event the applicant is a corporation, partnership, association, club, team or group, the person signing this agreement for such entity represents to the City that he/she has full authority to sign such contract and, in the event that he/she is not so authorized that he/she will be personally liable for the faithful performance of this agreement. The terms, conditions, policies and procedures along with this form shall constitute a contract between the applicant and the City of Bothell. 

    1. I certify that this is true, and that I am the correct point-of-contact with the City of Bothell for this reservation.
    2. No, I am not the correct point-of-contact for this reservation.
85. WAIVER OF LIABILITY*

    The undersigned hereby requests of the City of Bothell, use of the facilities above and certifies that the information in this request is true and correct. The undersigned agrees to exercise the utmost care in the use of these facilities and property and by signing below the applicant hereby agrees to indemnify, defend and hold harmless the City, its elected and appointed officials and employees while acting within the scope of their duties, from any and all claims, demands and causes of action of any kind or character, foreseen or unforeseen, for damages including but not limited to personal injury, death or property damage as well as the cost of defense costs, court costs, witness and attorneys’ fees, in any way arising out of the granting of this permit or arising out of the City’s sole negligence. Applicant expressly waives his/her immunity under Title 51 of the Revised Code of Washington, the Industrial Insurance Act, for injuries to his/her employees and agrees that the obligation to indemnify, defend and hold harmless provided for in this paragraph extends to any claim brought by or on behalf of any employee or representative of the applicant. I have received, read, understand and agree to abide by the field use Policies and Procedures contained in the Field Scheduling Guide. 

    1. I agree
    2. I do not agree
87. AGREEMENT

    I understand that by submitting this request form, I am not guaranteed the availability of requested fields or dates/times and I must wait for staff confirmation/a Facility Use Agreement before using fields for their requested purpose.

89. Please type your name/signature:*
90. Date:*
    Date:
Leave This Blank:


92. 1. Receive an email copy of this form.
93. Email address

    This field is not part of the form submission.

94. Submit

* indicates a required field