2. 
4. Roanoke County Parks, Recreation and Tourism Department Youth Athletics Field Rental Application
6. Name of Organization and Contact Person:
8. Street Address
10. City/State/Zip
12. Contact Information:
13. Cell Phone
14. Email Address
17. Day Phone
18. Evening Phone:
21. Birth Date:*
25. Youth Team Age Division: Please specify your team's age range.
27. Type of Event (check)

    1. Practice

    1. Game

    1. League

    1. Other
29. If other, please specify:
31. Preferred Area of Co. (check)

    1. North

    1. South

    1. East

    1. West
33. Type of Field Requested

    1. Baseball
    2. Softball

    1. Football
    2. Soccer

    1. Lacrosse
35. If other, please specify:
37. Preferred Date(s):
38. Time(s):
40. Preferred Field(s)

    Note: Please attach a list of any special needs or services you may require for this use. Roanoke County reserves the right to relocate your request to other locations in an effort limit the impact on existing programs or partnerships.

42. Event Information:
44. Number of Fields Requested
45. Base Path Length
47. Size of Fields Requested
48. Pitching Rubber Distance
50. Are Lights needed? ($20 per rental block)
51. Entry Fee Charge
53. Fees: Fees for youth practice and games will be based on the percentage of Roanoke County residents on the roster.

    
    Teams with 100% county residents - $40 per 2-hour block. (Roster with addresses required)

    Teams with 50% or more county residents - $50 per 2-hour block. (Roster with addresses required) 

    Teams with less than 50% county residents - $80 per 2-hour block.

    
    

55. Roanoke County reserves the right to require supervision staff, extra port-a-johns and/or security for your event. You will be responsible for any direct cost the department incurs as a result of your use. If you plan to charge admittance for your event please attach a detailed plan of your gates, ticket booths etc. Ticketed events can not interfere with the public’s ability to use a park and are subject to departmental approval.

57. Use of Roanoke County fields by applicants will require a $1 million liability insurance certificate listing the “Roanoke County Board of Supervisors” as additional insured (5204 Bernard Dr, Roanoke, VA 24018). No permit will be issued until proof of insurance is provided.

59. Roanoke County Parks, Recreation and Tourism reserve the right to cancel field usage in case of poor field conditions, weather, or other unforeseen circumstances. Reschedules or reimbursement may be available. When sports organizations rent athletic facilities, they will be provided goals, bases and fields which are safe for play. Baseball and softball fields may not be drug or lined the day of use and soccer fields may or may not be lined for play. Depending on the work load of maintenance; staff, additional services including field painting, lining and/or dragging may be scheduled at a cost to the user.

61. **Submission of this application does not constitute approval.**

    Once application is approved and payment is received a permit will be issued to the event contact person at the above address.

63. Print
64. Date
66. Signature
Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit

* indicates a required field