This undersigned applicant makes application for the use of the school district facility or equipment as designated below. The entity will provide security at its own expense, if necessary, to maintain order and to properly protect the facility or equipment. Security is required if admission is charged.

Please refer to Policy 905.1 to determine the proper use of school district facilities and equipment. The entity is responsible for complying with the law, board policy, and the administrative regulations.

This applicant must provide an Indemnity and Liability Insurance Agreement, Code No. 905.1E2, prior to the use of the facilities.

BUILDING:    _________________________          PURPOSE: ________________________

DATE:  ______________________________          HOURS:  __________________________

Auditorium                                                                 Gymnasium

Seating requirements on stage ____________           Seating            ________ Scoreboard __________  
Tables required on stage _________________  Public address system ________________  
Stage curtain and attendant _______________          Matron _____________________________ 
Spotlights _____________________________                                                              
Microphones __________________________          Classroom                                                   
Podium ____________   Stand ____________                                                                                    
Table _______   Stand in audience _________         Lunchroom                                                    
Other equipment ________________________                                                

TOTAL FEE $__________________________

Name of organization making application: ___________________________________________

Name of person making application: ________________________________________________

Address: _______________________________ Phone: ________________________________

 ______________________________________            ____________________________________
(Signature of Applicant)                                                           (Date)

The undersigned, hereafter referred to as entity states that it shall hold the Ruthven-Ayrshire Community School District, hereafter referred to as school district, its board of directors, individual board members, employees, officers, agents, and representatives harmless from any and all damages and claims that may arise out of the entity’s  use of any facilities or equipment owned by the school district       In case any action is brought therefor against the school district, its board of directors, individual board members, employees, officers, agents or representatives , the entity shall assume full responsibility for the legal defense thereof, and upon its failure to do so on proper notice, the school district reserves the right to defend such action and to charge all costs, including attorney fees, to the entity.

The entity agrees to furnish and maintain during the usage of the facilities owned by the school district such bodily injury and property damage liability insurance as shall protect the entity and the school district from claims for damages for personal injury, including accidental death, and from claims for property damages, which may arise from the ’entity’s use of the school district's facilities or equipment, whether such operations be by the entity or by anyone directly or indirectly employed by the entity.  Such insurance shall include the Ruthven-Ayrshire Community School District as an additional named insured in the policy carried by the entity and described above.

The entity shall furnish the school district with a certificate of insurance acceptable to the school district's insurance carrier before the contract is issued.

Dated at ___________________________, Iowa, this _____ day of ______________, 20_______,

_________________________________________  ______________ Community School District  (Organization)

By ________________________________  By _______________________________
            President

Title _______________________________  By _______________________________
                                                                                                             Secretary                                                                

Address ____________________________

              _____________________________

1.      Alcoholic beverages will not be brought to or consumed in school district facilities and on school district grounds.

2.      The use of tobacco and nicotine products are prohibited in school district facilities and school district grounds, including in private vehicles parked on school district grounds.

3.      A school district employee must be present while the school district facility or equipment is being used by an entity.

4.      After a school district facility or equipment has been used by an entity, cleaning, including restoring the facility or equipment to the condition it was in prior to its use, will be done by school district employees assisted by representatives from the entity.  The fee charged to the entity for the use of the facility or equipment will include these costs.  However, if excessive costs are involved in cleaning or otherwise restoring the facility or equipment to the condition it was in prior to its use, the board reserves the right to charge the entity for these excessive costs. 

5.      Entities are required to stay within the area of the school district facility and use only the school district equipment authorized by the school district for use by the entity.  Other school district facilities or areas in the school district building or equipment are off limits to the entity.

6.      A cancellation after the facility or equipment is made ready for the entity will be charged at the full rate.  Cancellations made prior to that time will be charged a minimum cancellation fee or the costs incurred to the school district in anticipation of the entity's use, whichever is greater.

7.      School district sponsored activities will always have priority over use of school district facilities and equipment requested by entities.

In addition to paying the above fees, each entity must make arrangements with the school district to have adequate custodial and supervisory services.  Buildings will not be available unless a contract is signed by the entity and the school district well in advance of scheduled usage.