377 Building Reservation Form V5

1.   Completion of the request for building reservation form is considered an official request for use.  Prior to approval of an official request for use the Central Office will complete a review of “known” references.  Groups/Organizations may be required to submit references to complete the request process.  Reference checks will be made to ensure that the renter/user’s are able to use district facilities in a responsible manner.

2.  Rental fees are payable in advance to USD 377, 306 Main., PO Box 289, Effingham, KS 66023-0289.  Fees are:  
                            $70.00 per meeting at all centers
                            $100.00 for use of the kitchen
                          $300.00 for use of building all day long
          Adjustments and approval will be made at the discretion of the Superintendent.

3.   The rental fee charged includes a limited amount of custodial service.  Custodial service included is: opening of the building at the time specified for the gathering; assisting with the operation of the school service systems; and closing the building when vacated. Should the services of school personnel be required due to the nature of the use request, the charges will be based on the per hour rate for such additional employee.  The charges for additional cook and/or custodial services are as follows:  
                                   $17 per hour for cook services (per cook)
                                   $17 per hour for custodial services (per custodian)

      *When kitchen equipment is used, a school cook may be required to be present.

       *The expectation is the facility is left in the same manner that it was found.  If excessive cleaning is  necessary, additional custodial charges will be required. 

4.  The buildings will not be scheduled for Holidays, including Mother’s Day & Father’s Day without advance approval from the superintendent of schools.  Furthermore, building will not be used when school is dismissed early because of inclement weather.  Forty-eight hours notice will be required of building being used.  If for any reason you find it necessary to cancel your reservation, a notice of such cancellation must be received in our business office not later than forty-eight hours preceding the time for opening the building.  In event such notice is not given, a charge shall be made for the expense incurred.  Custodian must be called if building reservations is cancelled.

5.  No alcoholic beverages, smoking, or tobacco products are allowed in school building.  No holes shall be cut, nor nails or screws driven into the school structures, walls, or floors by the renter/user.  When persons are using the building for any occasion, they should be responsible for clean up of their groups trash (pick up items such as Gatorade bottles, pop containers, and candy wrappers, etc.).

6.  The renter/user shall be responsible for warning people who are in the area of the school building rented by the above group/organization of impending severe weather and furthermore the renter/user is responsible for the prompt movement of these people to areas designated as storm shelters in the building.  It will be the renter/user’s responsibility to inquire of the school principal during the principal’s normal school working hours of the location of the designated storm shelter areas.

7.  The renter/user shall be responsible for turning off all lights, locking and shutting all doors.
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Email *
Organization or Name of Person Making Request
Type of Organization
Choose one only.
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Person in charge of activity *
Contact Person
Address of person responsible
Street address, City, State, Zip
Daytime Phone Number
Home Phone Number
Name and type of activity
Name of Facility Requested *
Setup Date (Date you would like access to set up for event.) *
Setup Start Time (Time you would like access to set up for event, on the set up date.) *
Setup End Time (Time you would be done setting up for the event, on the set up date.) *
Date of the Event *
Start time of the event *
End time of the event *
Will a cook be needed
Will a custodian be needed
Specific equipment, tables, chairs, extension cords, or personnel or food service needs.  Use of Kitchen?
Please add any other information that might be helpful.
Contact Person Email Address or confirmation phone number
Please enter a contact email address or phone number for reservation confirmation
Will a fee be charged to participants? *
This question is for persons/organizations charging participation fees.
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