Croix Bleue Medavie Stadium Reservation Form You must have JavaScript enabled to use this form. Applicant Organization Name Contact person Phone Cell Address Address City Province Postal Code Email Activity Information Activity date Type of request Seasonal One time Participants (Check appropriate areas) Youth Youth Adults (19+) Adults (19+) Number of participants Number of spectators Number of volunteers Activity Track and Field Soccer Other (please specify) Enter other… Liability Insurance Does your organization have liability insurance? Yes No If yes, please indicate the insurer’s name Liability amount Facility and Service Request Information INFIELD (TRACK) Date (start) Date (finish) Start time End time UPPER FIELD Date (start) Date (finish) Start time End time DRESSING ROOM Date (start) Date (finish) Start time End time SPECTATOR SEATS Date (start) Date (finish) Start time End time SPECTATOR BOX Date (start) Date (finish) Start time End time MEDIA ROOM Date (start) Date (finish) Start time End time STADIUM LIGHTS $35/hour after 6:30 p.m. Date (start) Date (finish) Start time End time J-TRACK Date (start) Date (finish) Start time End time Tentative Program of Activity: (Number of participants/Number of spectators/ Number of volunteers) Media Coverage: (before or during) Your specific request: lights, equipment, services, facilities (a list of what you are requesting ) Food and Beverage Requirements: (please specify if you are looking to sell or give) Any other information important to your application Copy of insurance (proof of insurance is only required after the event is approved. Event organizers must carry no less than $2 million in General Liability coverage for the event and designate the City of Moncton, Université de Moncton and M4I in case additional insured with respect to the event.) One file only.64 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.