Building Use Form
Building Use Form
Date of Application:
Applicant's Name:
Address:
E-Mail:
Telephone
Home:
Work:
Event Title:
Cell:
Organization:
Cell #:
Location:
High School
Middle School
NTH School
Alex Park
Bus Garage
Room(s) Requested:
Only Rooms listed will be unlocked for your use
End Date:
End Time:
(No Later than 9:30pm)
Door(s) to be unlocked:
Maintenance Services
Required:
Scoreboard
Tables (qty)
Chairs (qty)
Mic
Podium
Computer Services
Attendance
Food Services
Number of Adults:
Internet Connection
Kitchen Equipment
Number of Children:
Yes
No
If Yes, Name:
Certification:
As representative of the above mentioned organization, I agree to the Terms
and Conditions outlined on the back of this Facilities Use Application.
*NOTE: If there is an Early Dismissal due to bad weather or if
there is a Snow Day, there are
NO
Approved
or
Rejected Reason:
Dated:
(Signature)
cc:
Bldg Office
Custodian
Facilities Office
Athletic Director
Kitchen
IT/Library
Updated: 9/16/15
GENERAL LIABILITY *
-
EACH OCCURRENCE
DAMAGE
MED EXP
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS-COMP/OP AGG
$
$
$
$
$
$
1,000,000
300,000
5,000
1,000,000
2,000,000
2,000,000
OTHER
- PARTICIPANT ACCIDENT MEDICAL
1,000,000
l The use of school facilities is a privilege and not a right. Therefore, the
privilege may be withdrawn for cause at any time.
l Any fees that are due, are to be paid within 30 days of the invoice.
If
payment hasn't been received before your next Building Use Request, your request will
be denied until payment is made.
l AED/CPR certified personnel are not required for non-school groups or community
groups and activities.
initialed.