Form – Program Intake Program/Event Intake New Programs or event ideas from patrons "*" indicates required fields Name of Group/Company*Contact Name* First Last Address* Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Phone (daytime/evening)*MoblieEmail* Website Social Media handlesCategory* STEAM Fitness Food Music / Dance Technology Film / Theatre Health & Safety Outdoor Other OutdoorMore detail on the outdoor categoryTargeted Age Group* Adults Teens Children (4+) Preschoolers Brief Description of the program or event idea*Program/Event GoalsProposed Date 1*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear2045204420432042204120402039203820372036203520342033203220312030202920282027202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901190018991898189718961895189418931892189118901889188818871886Proposed Time 1* Hours : Minutes AM PM AM/PM Proposed Date 2MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear2045204420432042204120402039203820372036203520342033203220312030202920282027202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901190018991898189718961895189418931892189118901889188818871886Proposed Time 2 Hours : Minutes AM PM AM/PM Proposed Date 3MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear2045204420432042204120402039203820372036203520342033203220312030202920282027202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901190018991898189718961895189418931892189118901889188818871886Proposed Time 3 Hours : Minutes AM PM AM/PM Extra Details* Single Day Multi-Day This field is hidden when viewing the formLocation* Indoor Outdoor Do you feel as though this program is of value to the community? If so Why?Are there fees to the program/event?* Yes No If Yes, what are your fees?Other DetailsTerms and Conditions* I agree to abide by the terms and conditions throughout the application process and during the use of the APL facilities.I Understand* That submitting an application does guarantee that the proposed program or event will be approved. A representative from the APL will contact you to review your request and will be in touch with you if further information is required Depending on the time of year, this initial review could take up to four weeks.I Understand* I may need to provide evidence of insurance in the minimum amount of $2 million for each occurrence naming the Aurora Public Library as additional insured. I understand that the personal information on this form is collected pursuant to the Municipal Act, 2001, and will be used by the Aurora Public Library to determine eligibility. Should you have any questions about the collection and use of your personal information please contact Jodi Marr, Chief Executive Officer.Signature*Today's Date* MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged.
