2. License Agreement Application Form

4. This form is for Shaker-based organizations to complete to request use of City and School parks and facilities for programs. Organizations are required to have a minimum of 50% Shaker residents on the roster for the clinic or league activity to receive permission to use fields and gyms. A license agreement is required on an annual basis to receive access to space. Failure to abide by the license agreement conditions may lead to refusal of space in the future. Please complete this form in its entirety to receive space. Failure to include the certificate of insurance will delay the agreement process.

   The license agreement is required to receive a permit to use park, open space, athletic fields and gyms. Use of space is dependent on the availability of requested space and compliance with license agreement terms and conditions.

8. Association/Organization Information

10. Name of Association/Organization:*
12. Primary Contact Name:*
14. Primary Contact Phone Number:*
15. Primary Contact Email Address:*
17. Association/Organization Officers:*

    Please upload a list of officers' names, addresses, phone numbers, and email addresses. A Word document is preferred. 

21. requested location(s)

23. Please select your organization's preferred location(s).*

    1. Ludlow Field
    2. Shaker Median Field
    3. Sussex Park Field
    4. Chelton Park Field
    5. Towne Center Field
    6. Chesterton Athletic Fields
    7. Courtland Oval Athletic Fields
    8. Lomond Athletic Fields
    9. Boulevard Field

    1. Mercer Field
    2. Woodbury Front Lawn
    3. Middle School Lower Fields
    4. Middle School Upper Fields
    5. Onaway Oval
    6. High School Fields
    7. School District Indoor Facility
    8. Other
25. Additional Location Information

    If you selected "School District Indoor Facility" or "Other" in the previous question, please provide additional information here regarding your preferred location(s). If you have anything else to add regarding your preferred location(s), please do so here. 

27. Program Schedule*

    Please use this space to provide an outline of your organization's anticipated program schedule. Please list preferred day(s) and time(s) for organization activities, practices, and/or games. 

31. additional information

33. Association/Organization Insurance Certificates:*

    The association/organization completing this application must submit an insurance certificate naming the City of Shaker Heights as an additional insured with limits of at least one million dollars ($1,000,000) per person and three million dollars ($3,000,000) per occurrence.

    This information should be submitted to Erin Rose. Failure to submit the certificate of insurance will delay the agreement process.

    1. I understand this requirement and will submit all required insurance information.
35. Field Maintenance Fees: *

    If applicable, field maintenance fees may be collected by the City of Shaker Heights. Fees are $25 for the first player, and $16.75 for subsequent siblings.

    1. I understand this requirement and agree to pay field maintenance fees as applicable.
37. Applicant Residency: *

    The primary contact for the association/organization completing this application must be a Shaker Heights School District resident.

    1. I confirm that I am a resident of the Shaker Heights School District.
39. Participant Residency:*

    More than 50% of the membership of an association/organization and more than 50% of its participants must be Shaker Heights School District residents. 

    1. I confirm that more than 50% of the membership of this association/organization and more than 50% of its participants are residents of the Shaker Heights School District.
41. Participant Information:*

    A list of team members and full contact information for each (first name, last name, age, address, phone number, and email address) is required to be submitted one week prior to the first practice date. 

    This information should be submitted to Erin Rose. 

    1. I understand this requirement and will submit all required participant information by the specified deadline.
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field