Clark University
950 Main Street Worcester, MA 01610
Tel: 508-793-7711
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Athletics
DEPARTMENT OF ATHLETICS
DOLAN FIELD HOUSE/CORASH TENNIS COURTS/GRANGER ATHLETIC FIELDS
FACILITY REQUEST FORM
Organization Name( required):
Today's Date:
On-Campus Group
Off-Campus Group
Contact Person (required):
Contact Phone Number (required):
Room Number/Street Address:
Box Number/City, State:
Contact Email (required):
Date of Request (1st Choice):
Time Requested:
From-To
Date of Request (2nd Choice):
Time Requested:
From-To
Is your program profit or non-profit:
Profit
Non-Profit
Number of participants:
Number of spectators:
Approximate Number of Parking Spaces Needed
Ratio of adults to youth participants:
Name
of person who will be on-site during event
Day Phone
Night Phone
Cell Phone
Name and phone number of your
on-site medical person (Certified Trainer, EMT, etc.):
Name
Phone
Is there a fee charged to participants or teams? If yes how much?
Will there be an admission charge?
If Yes, How much?:
Will there be food, concessions, etc?
Facility Requested
Corash Tennis Courts
Dolan Field House (Total Area)
Dolan Field House (Partial Area)
Turf Field
Locker Rooms/Showeres
Other Please specify
Equipment Requested (in as much detail as possible
Please List
Purpose of facility request (Please be specific)
PLEASE NOTE THAT DEPENDING ON YOUR REQUEST AND NEEDS, THERE MAY BE FEES INVOLVED.
Please email additional information to Roxanne Ball and David Kulik as an attached file