CMS Application and Permit for Use of School Facilities

Application and Permit for Use of School Facilities

Carpinteria Unified School District, 1400 Linden Avenue, Carpinteria CA 93013
Application must be submitted at least two weeks in advance.
What Area of Carpinteria Middle School?*
Date and Start Time (if multiple Dates/Times needed, select one here, then type others below)*

MonthDayYear
Date
Hour MinutesAM/PM Option
End Time*

MonthDayYear
Date
Hour MinutesAM/PM Option
If multiple Dates/Times, let us know here.
Organization*
Purpose*
Estimated attendance:*
Will admission be charged or contributions solicited?*
If yes, will net proceeds be used for the welfare of the students of the District or for charitable purposes?
Staff Needed: Custodial (required for weekends and holidays) or Other list below:
Special Arrangements needed or other comments?
The undersigned states that, to the best of his or her knowledge, the school property for use of which application is hereby made will not be used for the commission of any act intended to further any program or movement, the purpose of which is to accomplish the overthrow of the government of the United States by force, violence or other unlawful means. That, the organization on whose behalf he or she is making application for use of school property, does not, to the best of his or her knowledge, advocate the overthrow of the government of the United States or of the State of California by force, violence or other unlawful means, and that, to the best of his or her knowledge, it is not a Communist action organization or Communist front organization required by la:w to be registered with the Attorney General of the United States. This statement is made under the penalties of perjury. $I, 000, 000 Certificate of Insurance Liability Required. I HAVE READ THE RULES, REGULATIONS AND POLICIES OF THE CARPINTERIA UNIFIED SCHOOL DISTRICT ON THE REVERSE SIDE REGARDING USE OF FACILITIES AND AGREE TO BE BOUND BY THEM.
ORGANIZATION REPRESENTATIVE (signed)

Clear
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
$1,000,000 Certificate of Insurance Liability and payment of fees are required 48 hours in advance of facility usage. Checks should be made payable to Carpinteria Unified School District. Permit must be carried while on school premises. Cancellations require 48 hours notice.
Should be Empty:

Application and Permit for Use of School Facilities

Application must be submitted at least two weeks in advance.

$1,000,000 Certificate of Insurance Liability and payment of fees are required 48 hours in advance of facility usage. Checks should be made payable to Carpinteria Unified School District. Permit must be carried while on school premises. Cancellations require 48 hours notice.