Joint Use Application Form

Application/Organization Contact Information

Facility Request Information

If you are requesting more than one day a week or specific days each month, please attach your list or specific dates on another page. All of the information must be completed and submitted using this request form

Program Information

The personal information collected on this form will be used to administer facility bookings under the Joint Use Agreement for the City of Medicine Hat. This personal information is being collected in accordance with the Freedom of Information and Protection of Personal Privacy Act and will only be shared with third parties with your written permission.

Eligibility Criteria for Joint use facilities:

1. Approved application will require the following:

o Insurance certificate

o Residency (see next page)

 **Please note this is an application from only, final approval depends on a review of all applications   

Please accept this form as my application for the facilities indicated above. I hereby state the facilities have been requested exclusively for the group I represent. As the Permit holder, I understand that I must notify the Recreation Facility Coordinator one month prior for tournaments and 5 business days for single bookings for cancelations.