The undersigned entity makes application for the use of the school district facility or equipment as designated below. The entity will provide police protection at its own expense, if necessary, to maintain order and to properly protect the building, site, or equipment. Police protection is required when admission is charged.
Please refer to Policy 905.1 to determine the proper use of school facilities and equipment. The entity is responsible for complying with the law, board policy and the administrative regulations.
The entity must provide an Indemnity and Liability Insurance Agreement, Code No. 906.1E2, prior to the use of school district buildings, sites, or equipment
Building/Site Equipment __________________________________________ Date ___________________
Purpose ______________________________________________________ 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 ____________________________ ICN ____________________________________
Table _______ Stand in Audience ___________ Computer lab ____________________________
Other equipment __________________________ Other __________________________________
Swimming Pool
Total Fee $__________
Name of entity making application: _____________________________________________________________
Name of person making application: ____________________________________________________________
Address: __________________________________________________ Phone # _______________________
______________________________________________________ _________________________________
(Signature of Applicant) (Date)