facility_use_application_1314_sem
 Share
The version of the browser you are using is no longer supported. Please upgrade to a supported browser.Dismiss

 
View only
 
 
Still loading...
ABCDEFGHIJKLMNOPQRSTUVWXY
1
Form 65
2
Northwest Regional ESD - Washington County Service Center
3
Application and permit for Use of ESD Buildings and Facilities
4
5
6
Print and complete the following application for all Washington Service Center facility use. NWRESD requests room reservations are to be made a minimum of one week in advance of your meeting and no more than 3 months in advance. NWRESD reserves the right to relocate your meeting room if necessary; however, every attempt will be made to accommodate your requests. Business hours are Monday through Friday 8:00 am to 4:30 pm. Questions? Lynn Williams at 503-614-1428 or lwilliams@nwresd.k12.or.us.
7
8
9
Name of Meeting/Type of ActivityDate(s) of EventBeginning Time
Ending Time
10
11
School/ Non-Profit OrganizationFacilitator/SponsorTelephone
# of Participants
12
13
14
Meeting RoomsRoom SetupHOURS Fees Per Hour
ESD Use Only
15
(Please see Fee Schedule tab for Class)(Enter appropriate fee from your Fee Schedule Class)Total Cost
16
List Hours of Use.
Class I
Class II
Class III
Class I
Class II
Class III
17
Washington Room West (Room 503; Maximum Capacity 36)
Please Select OneHrs @No fee $ -
18
Washington Room East (Room 502; Maximum Capacity 36)
Please Select OneHrs @No fee $ -
19
Washington Room East & West (Room 502 & 503; Maximum Capacity 72)
Please Select OneHrs @No fee $ -
20
Clatsop Room (Computer Lab; Room 505; Maximum Capacity 21)
Fixed Setup (21)Hrs @No fee $ -
21
Columbia Room (Room 506; Maximum Capacity 16)
Horseshoe (Fixed Setup; 16)
Hrs @No fee $ -
22
Tillamook Room (Computer Lab; Room 507; Maximum Capacity 19)
Fixed Setup (19)Hrs @No fee $ -
23
GED Room 222 (Maximum Capacity 30)
Rectangle (Fixed Setup; 30)
Hrs @No fee $ -
24
Room 315 (Maximum Capacity 38)
Please Select OneHrs @No fee $ -
25
Room 316 (Maximum Capacity 38)
Please Select OneHrs @No fee $ -
26
Room 315/316 (Maximum Capacity 76)
Please Select OneHrs @No fee $ -
27
Room 223 & 224 (Maximum Capacity 12)
Fixed Setup (12)Hrs @No fee fgsdg
28
Instructional Conference Room (Room 411; Maximum Capacity 10)
Fixed Setup (10)Hrs @No fee dfg
29
Special Student Conference Room (Room 212; Maximum Capacity 8)
Fixed Setup (8)Hrs @No fee dfg
30
Technology Conference Room (Room 300; Maximum Capacity 12)
Fixed Setup (12)Hrs @No fee $ -
31
TOTAL: $ -
32
33
EQUIPMENT:
List # of Days Equipment will be usedFee Total
34
Please select any equipment that is available for the room being requested.
Class I
Class II
Class III
Class I
Class II & III
35
Data Projector
Days @No fee$15.00 $ -
36
Document Camera
Days @No fee$15.00 $ -
37
Flip Chart Stand
Days @No fee$5.00 $ -
38
Large Conference Phone
Days @No fee$15.00 $ -
39
Microphone
Days @No fee$15.00 $ -
40
OverheadDays @No fee$15.00 $ -
41
Partition (rooms 315/316 and Washington Rms)
Days @No fee$15.00 $ -
42
Podium (Available only in the Washington Room West)
Days @No fee$5.00 $ -
43
Printer (Available only in the Clatsop & Tillamook Room)
Days @No fee$15.00 $ -
44
Screen from ceiling
Days @No fee$15.00 $ -
45
TOTAL: (Items, Hours, Fees) $ -
46
47
CUSTODIAN (Optional):
48
Custodial hours calculation:HoursFee (per hour)Total
49
Minimum 3 hours (regular time)$40.00 $ -
50
Minimum 3 hours (overtime) $45.00 $ -
51
Minimum 3 hours (Sunday/holiday) $50.00 $ -
52
TOTAL CUSTODIAN CHARGES: $ -
53
TOTAL CHARGES: $ -
54
55
56
57
58
Please read the Condition of Use and write your initial in each condition indicating you have read and understand the responsibility in order to complete the application.
59
60
61
Conditions of Use
62
Representatives of the group using the Washington Service Center will exercise care in protecting the agency and will provide adequate supervision and first aid necessary for participants. In the event damage results, the facility user will assume liability for repairs.
63
64
65
User will designate a "person-in-charge." The person in charge shall be at the site for the entire time the facility is used. If this is not possible, another adult name on the application must be present and designated as being in charge of the group.
66
67
68
Room setups will be available 30 minutes prior to event. If more time is needed for setup, schedule appropriate amount on the application.
69
70
Groups applying as adult groups shall be maintained as an adult group. Members of these groups must be 18 years of age or older.
71
72
The person in charge of the group using the facility is responsible for restricting use to members of his/her group, and to the area for which the application is made for.
73
74
75
User can not make any other modification that is not specified in the request without prior written approval from the building administrator.
76
77
During business hours, lunch room, hallways, and common areas cannot be used as breakout sessions.
78
79
Unless otherwise specified, use of district equipment (e.g. phones, copiers, computers, etc.) is prohibited.
80
81
User shall not store items on the premises without prior written approval from the building administrator.
82
83
Groups must bring their own supplies such as chart paper and meeting handouts. NWRESD does not provide chart paper. Copies can be made for .20 cents per opy at the front desk (PO or Credit card) is accepted.
84
85
Groups are not allowed to tape or tack items to the walls.
86
87
The user agrees to set up room back to rectangle (2 tables) or fixed setup. Must leave room in good condition, or better than, when it was authorized for use. All garbage will be removed from the site (user shall not use district-provided containers for this purpose).
88
89
90
User must provide adequate restroom/toilet facilities for outside use at their own expense. Specific placement is to be determined by the Facilities Director or his/her designee.
91
92
93
Any violation or disregard of district policy will result in automatic forfeiture of the right to make future requests.
94
95
The possession/use of drugs, tobacco, or alcohol, use of profane language and rowdy conduct on ESD property are strictly forbidden.
96
97
Partitions cannot be closed or open during day of event without notice 5 working days prior to event.
98
99
Each party shall hold harmless, indemnify, and defend the other for any claims, loss or damage arising out of, or resulting from, each parties own respect use of the premises.
100
Loading...
 
 
 
Application and Permit Use
Sheet2
Fee Schedule
Sheet3