CC Facility Use Request

Name

First NameLast Name

Name of Group or Organization:

Email

example@example.com

Address of Person Requesting

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number of Contact Person, Including Area Code:

Please enter a valid phone number.

What Percentage of Participants are Central Cambria students?

Less than 75%More than 75%100%

Facility Requested

Start Date for Facilities Use

Date

End Date for Facilities Use

Date

Day or Days of the Week

Start Time You Are Requesting to Use the Facility:

Hour Minutes

AM/PM Option

End Time You Are Requesting to Use the Facility:

Hour Minutes

AM/PM Option

Approximate Number of People Who Will be Using the Facility (Participants & Attendees):

Please provide a description of the event / activity you will be using the facility for:

In making this request, I/we fully understand and accept the following conditions: 1) Building and ground requests will not be approved on scheduled school holidays. 2)Your function is subject to cancellation if school is closed for any emergency or for any unscheduled building closing. 3)The hour(s)/date(s) stated for use on this application will be the actual time and/or date(s) the building may be occupied. 4) User assumes responsibility for all participants and/or spectators for all liability, not limited to injury resulting from accidents, arising out of users acts or omissions; and to that extent, user agrees to save and hold harmless the Board of Education of the Central Cambria School District from any suit, claim, or demand as the result of Bodily Injury or Property Damage arising out of users’ acts or omissions during occupancy. 5) Upon request, the user will present to the school district a certificate of insurance evidencing the following minimum coverage: General liability and auto liability insurance (property damage and bodily injury) at amounts equal to or greater than the amounts carried by the school entity. 6) The school entity must be named as an “additional insured” on all certificates. 7) If the outside group is a business group, they must also carry their own worker’s compensation insurance, as required by law. 8) Alteration or relocation of items is prohibited unless prior approval has been granted. 9) Use or possession of alcoholic beverages or tobacco/tobacco-like products (i.e. e-cigarettes) is prohibited on school premises. 10) The user will strictly comply with all fire and safety codes. 11) Upon request, the user will present to the school district copies of required background check clearances of adults supervising the event/activity. 12) Compensation will be made to the school district for time and materials to correct loss or damage to school property resulting from use. 13) All use fees (if applicable) will be made to the School District for time and materials to correct loss or damage to school property resulting from use. All use fees will be paid to the school district within ten (10) days from the date of invoice.

I have read the above regulations and agree to all the conditions listed.