Scott Township Door Access Request Form
Please note door access is reviewed/approved as needed. If you have an EMERGENCY, and need access, please call the office. 812-297-0749
Name of the Requester
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First Name
Last Name
Email (Your will receive your electronic access to this email)
*
example@example.com
Cell Phone Number (This number will be used for access)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Cell Phone Carrier
*
Request Date
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Month
-
Day
Year
Date
Will your request be temporary or permanent?
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Temporary (Coaches, Volunteers, etc.)
Permanent (Contractors, Vendors, etc.)
Date you need access to begin
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Month
-
Day
Year
Date
If temporary, date access should expire. This will be confirmed at a later date.
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Month
-
Day
Year
Date
Company or Volunteer Organization
*
Reason for access
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Which locations do you need access to?
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Scott Township Ballpark (Radio Ave)
Scott Township Park (Schlensker Rd)
Both parks
Other (Please list below)
Please list the access you are requesting. Be sure to include the which building, and/or door information. If you have multiple doors, be sure to include them all. The more information the better! (If you are a volunteer or coach for one of our youth sports programs, simply type, "Coach Access"
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Please upload a copy/picture of your state issued ID. This is to confirm your identity.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
You agree that the access you will be granted is for the use and intended purpose only. Your access may not be shared with anyone else. Access can be revoked at any time for any reason. Unless specifically requested, access will be granted using a third party app or key card. Third party app is utilized via smartphone. Any re-issued key/token issue will require a $50 deposit.
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I agree
Signature
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Please verify that you are human
*
Submit
Submit
Should be Empty: