SHREWSBURY TOWNSHIP

                                  12341 Susquehanna Trail S.

                                   Glen Rock, PA 17327-9067 

                                              717-235-3011

 

 

Text Box: REQUEST FOR USE OF RECREATION FACILITY

 

                 NAME OF REQUESTOR_____________________________________________________

 

                ADDRESS ________________________________________________________________

 

                PHONE_____________________________

 

 

Text Box: FACILITY REQUESTED_____________________________________________________________   DATE REQUESTED_____________________________________________________________   USE OF REQUEST______________________________________________________________

 

 

 

  

Text Box: FEE ATTACHED: _________ YES                          __________NO                           RESIDENT - $10.00                           NON-RESIDENT - $25.00

 

 

 

 

 

 

 

 

            SCHEDULED BY:_____________________________  DATE_____________

 

Please mail or e-mail to the township office.