905.1E1 - Use of School District Facilities and Equipment Application Form

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)