Elementary School Facility Request
Group Information
All Requests Must be Submitted 15 Days Prior to Use/Activity:* PLEASE CHECK CLASS Class A: N/A Class B: $1,000,000 Class C: $1,000,000 Class D: $1,000,000
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Class A: School Organizations, Clubs, PTO, Booster Clubs, Band Parents, Alumni, Etc.
Class B: Non-fund raising activity, Little League, Boy/Girl Scouts, Civic Group, Etc. $1,000,000
Class C: Civic or community group that involves fund raising and pays rental fee. $1,000,000
Class D: Any outside organization which meets Board Policy and pays rental fee. $1,000,000
Any civic or community group or organization offering to present a program, instructive and beneficial to the participants that involves fund raising and/or an admission fee?
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Yes
No
Type of Organization:
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School Affiliated
Non School Affiliated
Event Name
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Group Name
Contact Name
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First Name
Last Name
Contact Number
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Format: (000) 000-0000.
E-mail
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example@example.com
Event Information
Event Start Date
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/
Month
/
Day
Year
Date
Event Time
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Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Requested Facility:
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Elementary Cafe
Elementary Gym
Other
Additional Information such as: setup by Security, Technology, Custodial, Athletic and or Cafeteria Staff (if needed). Please also explain in detail any other important information for us to help make your event a success! Please put No or N/A here if no setup or assistance form the district is required.
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Sign Here: By “Signing” above you hereby agree to abide by all rules and regulations and make such payments as approved by the Board of School Directors governing the use of said facilities and equipment. Furthermore, you… 1.) agree to exercise discretion regarding the use of said facilities and equipment, to make all necessary arrangements for the services of approved personnel, to assume responsibility for damage of school property and equipment, to use only those facilities and areas as stated above, and to assume all responsibility for the actions and conduct of the participants. 2.)agree to hold the school district harmless from all claims for injury to or the death of any person and for damage to or loss of any property arising out of or attributed directly or indirectly to the operations or omissions of the school district. 3.)indemnifies the school district for all damage to property belonging to the school district and for all injuries to the deaths of any representatives or employees of the school district resulting from all acts or omissions or use. 4.)acknowledge that the school district is not responsible for user’s property. 5.)agree that user must arrange all protective services desired by user. 6.)agree that the school district is not liable for the acts or omissions of any protective services engaged by user. 7.)understand that the school district may cancel any scheduled events on short notice for district use. (Games, repairs, etc.) 8.)MUST INCLUDE A COPY OF YOUR LIABILITY INSURANCE FOR YOUR ORGANIZATION IF APPLICABLE. Please sign below indicating that you have read and agree to the policy.
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