7124 Leesburg Pike

Falls Church, VA 22043

703.248.5684 (office)

571.221.8229 (cell)

703.248.5687 (fax)

Athletic Facility Request Form

RECTANGULAR(Synthetic Turf) FIELD

General Guidelines

All groups requesting exclusive use of an athletic facility must complete a Facility Request Form.

Eligible groups requesting space should submit a request to the FCCPS Facilities Coordinator. All requests submitted will be processed on a "space available" basis. All requests must be approved by the FCCPS Facilities Coordinator, FCCPS Athletic Director, and the City of Falls Church Park and Recs Department.

Athletic facility requests must be in writing on the appropriate form and be submitted in person, mailed, emailed to or faxed to the above fax number. No Reservations can be made over the telephone. Incomplete applications will not be processed.

Field Reservation Fees

SPACE / Fee per Hour
GROUP I / Fee per Hour
GROUP II / Fee per Hour
GROUP III / Fee per Hour
GROUP IV
Application Fee (Non-Refundable) / $35 / $40 / $50 / No Charge
GMHS Stadium
GMHS Stadium With Lights
Stadium field lining (materials fee per use) / $50
$75
$45 / $75
$100
$45 / $125
$150
$45 / $50
$75
$45
PERSONNEL / Fee per Hour
GROUP I / Fee per Hour
GROUP II / Fee per Hour
GROUP III / Fee per Hour
GROUP IV
Field Supervisor (required for all events) (2/event)
Security (required for all spectator events) (2/event)
Police (available upon request) (each) / $75
$75
$60 / $75
$75
$60 / $75
$75
$60 / $75
$75
$60
RECTANGULAR SYNTHETIC FIELD RESERVATION REQUEST FORM

This form is to be used when requesting a Falls Church City Public Schools rectangular field for a single use during a specific season. The Facilities Coordinator will make every effort to comply with your request but makes no guarantee to do so. This form must be filled out completely. Incomplete forms will be returned. Please include zip code, work and home telephone numbers. Please make all checks payable to Falls Church City Public Schools. Send this request form along with your reservation fees to the Facilities Coordinator, Falls Church City Public Schools, 7124 Leesburg Pike, Falls Church, VA 22204.

Please Complete the Following Information Below:

League / Organization / Business:
First Name of Applicant: / Last Name of Applicant:
Address of Applicant:
City: / State: / Zip Code:
H-Ph: / W-Ph: / Cell: / Fax:
E-mail Address (Print Clearly):
Location: / Starting Date: / Ending Date:
Size of the Group: / Anticipated Number of Spectators:
Days of the week requested: / Number of weeks requested:

7124 Leesburg Pike

Falls Church, VA 22043

703.248.5684 (office)

571.221.8229 (cell)

703.248.5687 (fax)

The undersigned is aware that there are certain inherent risks involved in participating on FCCPS athletic facilities including but not limited to the risk of theft or of damage to my property, and the risk of personal injury from participating in athletic activities. In consideration of my being granted permission to participate in these activities and to use the facilities of FCCPS, and/or other activities and services provided by the Falls Church Department of Parks, Recreation, its agents and employees, including food service, I, on behalf of myself, my executors, administrators, heirs, next of kin, and successors, hereby covenant to hold harmless and indemnify the City and all of its officers, departments, agencies, agents and employees from any and all claims, losses, damages, injuries, fines, penalties, and costs (including court costs and attorney's fees), charges liabilities, or exposures, however caused, resulting from or arising out of or in any way connected to my or my family’s participation in the above described activity. I have read and understand this HOLD HARMLESS AGREEMENT and by my signature agrees to its terms.

Applicant Signature______Date______

FCCPS Representative Signature______Date______

Falls Church Park/Rec Dept. Signature______Date______

(If applicable)