by Leon Younger & PROS; Jeff Coates, creator and field tester
7168 North Graham Rd., Suite 150 Indianapolis, IN 46250 Telephone 317-578-7881
The following organization is entering into agreement with Park and Recreation Department:
Contact Persons
Park and Recreation Division Responsible: ____________________________
Contact Name: __________________________
Phone #: ____________________________
Fax #: ____________________________
Address:___________________________
City:____________________________
State: ____________________________
Zip Code: ____________________________
Location of Project/Program
Venue Name: ____________________________
Department Venue? ___ Yes ___ No If not, who owns? ____________________
Address:___________________________
City:____________________________
State: ____________________________
Zip Code: ____________________________
Public Served (Target Market) By Project/Program
Families (parents and children together) ___ Yes ___ No
Age Group (check all that apply): ___ Youth (17 & under) ___ Young Adult (18-24) ___ Baby Boomer (25-50) ___ Senior (50 & over)
Sex (check only one): ___ Male Only ___ Female Only ___ Both Male and Female
Geographic Target: ____________________________
Other Demographics of Target Group:
____________________________
____________________________
Start/End of Working Agreement Start Date: ____________________________
End Date:____________________________
Goal Measurement
Park and MeasurementPark & Recreation Goals (Desired Outcomes)How Measured?By Whom?
When? x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Community PartnerCommunity Partner's Goals (Desired Outcomes)How Measured?By Whom?
When? x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x
Park & Recreation Dollar Value ContributionPersonnel Services (staff consulting, labor, volunteer time, etc.)Date Contribution Committed
Dollar Value of Contribution Full time staff time @ $___/hour x x Seasonal staff time @ $___/hour x x Volunteer time @ $___/hour x x x x x x x x Supplies/Material/Items (Consumable) x x x x x x x x x x x Equipment (Non-Consumable) x x x x x x x x x x x x x x Facilities x x x x x x x x x x x Other x x x x x x x x x x x Cash Commitment Date Committed Cash Amount x x x Total Park & Recreation ContributionGrand Total (Cash + Dollar Value)
x x x Community Partner Dollar Value ContributionPersonnel Services (staff consulting, labor, volunteer time, etc.)Date Contribution Committed
Dollar Value of Contribution Full time staff time @ $___/hour x x Seasonal staff time @ $___/hour x x Volunteer time @ $___/hour x x x x x x x x Supplies/Material/Items (Consumable) x x x x x x x x x x x Equipment (Non-Consumable) x x x x x x x x x x x x x x Facilities x x x x x x x x x x x Other x x x x x x x x x x x Cash Commitment Date Committed Cash Amount x x x Total Park & Recreation ContributionGrand Total (Cash + Dollar Value)
x x x
Projected revenue to be kept for Park and Recreation: ____________________________
Projected revenue to be kept for Community Partner: _____________________________
ONGOING COMMUNICATION Both parties agree to communicate in the following way: __________________________ ________________________________________________________
At the following intervals: ____________________________
INSURANCE Complete the insurance information requested below in effect for this agreement.
Park and Recreation Department Type of insurance offered: ____________________________
Who is covered: ____________________________
Limits & Limitations: ____________________________
Community Partner Type of insurance offered: ____________________________
Who is covered: ____________________________
Limits & Limitations: ____________________________
AGREEMENT TERMS Both parties agree to the following:
Community Partner Signatures:Park & Recreation Signatures:
_____________________________ Community Partner Executive _____________________________ Director _____________________________ Title _____________________________ Date _____________________________ Date _____________________________ Partner Project Contact _____________________________ Park & Recreation Project Contact _____________________________ Department/Title _____________________________ Department/Title _____________________________ Date _____________________________ Date
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