Burrillville / Glocester Youth Soccer Complex
Field Use Permit

Anyone requesting use of the fields at the Burrillville Glocester Youth Soccer Complex, located at 1407 Putnam Pike, Chepachet RI are required to have permission from the BGYSA Board of Directors.

The BGYSA Board of Directors require the applicant to fill out the field use permit form located below.

This form will provide them the information needed to make a decision concerning the request being made. These applications should be submitted at least 45 days ahead of the time being requested if possible.

If you have problems submitting this form, type in the information, then print the page and
mail application to:

Mirko Bigwood
BGYSA President
763 Cooper Rd
Chepachet, RI 02814
401-568-3977 (home)

No one is allowed to use the property without written approval from BGYSA. You will receive a return email when your request has been approved.  Print that email and make sure it is with you on the nights you use the property to show that you have been granted permission, for those that might want confirmation at the field.

If you have any questions, please contact Mirko Bigwood at the phone number above.

(Fields marked with an asterisk * are required)

*Requestor:

Organization:

*Please specify which field(s) is being requested per the layout below by checking field number.
Note: Field One is the closest one to Putnam Pike.

Field Two

 

Field One

 

Field Three

 

Parking Area

 
 

Please check off the following information in each category concerning your request:

Program:
Fall Recreation
Spring Competitive
Soccer Camps

Other Requests:

 
Repetitive Requests:
 
Every (week day):
(to select more than one day,
hold down your CTRL key): 		 Starting date: Ending date:

Start time: End time:

Single event:

Date: Start time: End time:
 
    *I agree to follow all rules and regulations established by the BGYSA Board of Directors when using the above facility.
Violating any of the rules and/or regulations may result in the revocation or suspension of this permit.

 

*Signature of requestor:
(Typing your name in the above box will be considered your signature)

*Email Address:
Address:
City:   State:   Zip:
Phone:  

Facility rules: Obey all posted signs, no alcoholic beverages, no smoking or tobacco use, no abusive language, no littering, no pets allowed on property.

All requests should be made 30 - 45 days in advance for approval process.