PTHS209 Facilities Usage Form

Proviso Township High School District 209

FACILITY USAGE APPLICATION
- Please submit Facility Usage Applications, Certificate of Insurance, and Fees at least 14 days in advance.
- Facility usage is not approved, nor space reserved until the following are completed:
o Receipt of Facility Usage Application

o   Receipt of Certificate of Insurance

o   Receipt of Security and Maintenance Fees

o   Receipt of Facility Usage Fees, if applicable
- Cancellations must be received in writing three (3) days prior to scheduled event. Failure to notify us will result in your organization being responsible for the custodial service fee incurred due to preparing the facility for your use.
Campus Requested? *

Proviso East High School Proviso West High School PMSA
Building / room / area requested" *
Date of event *

Month Day Year
The District reserves the right to reject any request for any lawful reason and to terminate any agreement at any time the sponsoring organization’s use of District property/facilities ceases to be in the District’s best interests.
Event Start Time

Hour Minutes

AM/PM Option
Event End Time

Hour Minutes

AM/PM Option
# of hours to host event *
If dates are recurring, please specify additional dates and times.
Name of organization: *
Name of event: *
Tell us about your event (purpose, mission, etc.) *
Name of requestor / person in charge of the event *

First Name Last Name
Title *
Is requestor legally authorized to act for the organization? *

Yes No
Address *

Street Address

Street Address Line 2

City State

Zip Code
Daytime Phone Number *
Evening Phone Number *
Email *
example@example.com
Approximate attendance *
Age / school level of participants (Check all that apply): *

Elementary school age Middle school age High school age College Adults
Will an admission fee be charged? *

Yes No
Admission fee
Will participants be asked for a donation/voluntary collection? *

Yes No
Will you need access to electricity? (electrical fee will apply) *

Yes No
GENERAL LIABILITY INSURANCE

The Proviso Township High School District 209 requires all facility usage requestors to have General Liability Insurance to use District 209 facilities, as follows:

General Liability $1,000,000 per occurrence

Aggregate $3,000,000

Personal & Adv Injury $1,000,000

Each Occurence $1,000,000

Fire Damage (any one fire) $50,000

Med Exp (any one person) $5,000

The following wording must be listed in the "Certificate Holder" box:

Additional Insured

Proviso Township High Schools

8601 West Roosevelt Road

Forest Park, IL 60130

We know that facility usage requestors are providing a valuable service to our community, and we want to support your efforts. At the same time, we must be responsible and assure that the Proviso Township High School District 209 is adequately protected against liability. The cost of acquiring liability coverage may require a bit of pre-planning. However, the cost of liability insurance is minimal, when compared to the cost/liability exposure, should an unforeseen accident occur.
Please upload your Certificate of Insurance - drag your file to the box, then click "upload" in the bottom right corner. *
FACILITY USAGE FEES

Class I Events - subject to Security and Maintenance fees; not subject to facility usage fees.

Ø Tax supported bodies within District 209 and their affiliated organizations.

Ø Non-profit community groups within District 209, which are supported by voluntary contributions; whose purposes, in some degree, parallel those of District 209.

Ø Charitable, municipal, civic organizations within District 209 boundaries. Such organizations will include, but may not be limited to:
• High School athletic camps/programs sponsored by the school
• Band sponsored events
• Booster organizations
• District employees for personal use for athletic purposes only
• IHSA meetings and events
• Alumni reunion events
• PRE-approved collaborative programs which serve District 209 students
• Proviso Township Park Districts
• Proviso Township Police and Fire Departments
• Village governmental bodies within District 209 boundaries
• All other school sponsored camps (not high school students)
• Youth organizations serving District 209 students

Class II Events - subject to Security and Maintenance fees; also subject to facility usage fees.

Ø Organized adult athletic leagues

Ø Business, fraternal & social organizations

Ø Political parties

Ø For profit local organizations

Ø Non-public schools within District 209 boundaries

Ø Public schools outside District 209 boundaries

Ø All out-of-district for-profit entities

Ø Churches
Facility Usage Fees - Applies to Class II Events *
Approximate Attendance
# of hours to host event
Will you need access to electricity? (electrical fee will apply)

Yes No
OFFICE USE: Labor Fees - Applies to Class I and Class II Events. Fees will be calculated for you based on the approximate attendance and the # of hours to host the event.

TERMS and CONDITIONS:

1) All persons involved in, or attending functions of the sponsoring organization must conduct themselves in an orderly fashion and abide by District 209 rules at all times;

2) The sponsoring organization’s activities are of a nature consistent with the purposes of a public school, Proviso Township’s Board of Education Policies, and consistent with all applicable statues, regulations, and case law;

3) The sponsoring organization executes and abides by the terms of the District 209 Agreement for the use of Proviso Township High School District 209 property or facilities;

4) The sponsoring organization delivers an acceptable Certificate of Insurance to District 209, and maintains all required insurance coverage;

5) The sponsoring organization and all persons participating in its function must abide by District 209 policies & regulations;

6) The sponsoring organization’s use of the District’s property/facilities remains in the best interests of District 209;

7) Any food and/or beverages brought onto District 209 property which are prepared by members of the Organization or unlicensed individuals shall not be permitted unless the organization has a valid certificate of insurance which provides liability coverage for such items. Any food and/or beverage items brought onto District 209 property which are prepared by licensed vendors may be permitted, so long as items meet any specific Health rules, regulations and/or statues. In any event, District 209 shall not be liable for any food and /or beverage items, brought onto District 209 property, which have not been prepared by District 209 Food Services Department;

8) School facilities are available to the community during non-school hours when such does not (a) interfere with any school function or affect the safety of students or employees, or (b) affect the property or liability of District 209;

9) The use of District 209 facilities for school purposes has precedence over all other issues. District 209 reserves the right to cancel previously scheduled use of facilities bycommunity organizations and other groups.

10) The District reserves the right to reject any request for any reason and to terminate or renegotiate any agreement at any time the sponsoring organization’s use of District property/facilities ceases to be in the District’s best interests or .
Signature *

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Proviso Township High School District 209