Greater Pikesville Recreation Council, Inc - New Program Initial Contact

Greater Pikesville Recreation Council (GPRC) welcomes new program ideas in our goal of bringing outstanding recreational opportunities to our community’s youth and adults. Priority is given to programs that are not currently offered. All new GPRC member programs should have a volunteer chairperson that lives in the greater Pikesville community.

DATE: ______________

PERSON SUBMITTING REQUEST

NAME:	EMAIL:
ADDRESS:
PHONE (H): ( ) -	PHONE (C): ( ) -

VOLUNTEER PROGRAM DIRECTOR (IF DIFFERENT FROM SUBMITTER)

NAME:	EMAIL:
ADDRESS:
PHONE (H): ( ) -	PHONE (C): ( ) -

Program Name:
Brief Description:
Targeted age group(s):
Community “Need” For Program:
Facilities needed, including dates and times:
Estimated Participant Cost:

Please provide at least two references for Volunteer Program Director.

REFERENCE #1:

NAME:	EMAIL:
PHONE : ( ) -	RELATIONSHIP:

REFERENCE #2:

NAME:	EMAIL:
PHONE : ( ) -	RELATIONSHIP:

COMPLETE THIS FORM AND EMAIL TO: info@pikesvillerec.org