Code No. 905.1E1
SOUTHEAST WEBSTER-GRAND COMMUNITY SCHOOL
PRAIRIE VALLEY COMMUNITY SCHOOL
SOUTHEAST VALLEY SCHOOL
COMMUNITY USE OF SCHOOL DISTRICT FACILITIES & EQUIPMENT APPLICATION FORM
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, Policy 905.1E2, 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
Employee
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)