Facility Use Request
Your Name *
Your answer
Email Address *
Your answer
Mailing Address *
Your answer
Contact Phone Number *
Your answer
Facility Requested *
Room Requested *
Your answer
Beginning Date of Facility Use *
Your answer
Beginning Time of Facility Use *
Your answer
Ending Date of Facility Use *
Your answer
Ending Time of Facility Use *
Your answer
Event Title *
Your answer
Event Start Time *
Your answer
Event End Time *
Your answer
More Date / Time Info
Your answer
Public Event *
Level *
Purpose / Type of Activity *
Your answer
Special Equipment Required (Chairs / Tables)
Your answer
Estimated Attendance *
Your answer
Admission Charged *
Custodial Needs *
Performing Arts Center Needs Only
Facility Use Agreement
In consideration of using the Wautoma Area School Districts facilities, the above party hereby agrees to hold the Wautoma Area School District harmless for any and all injuries that occur to anyone associated with your event including, but not limited to, members, guests, attendees, invitees, instructors, staff, volunteers, and participants.

Also, the above party hereby agrees to waive any right of subrogation against the Wautoma Area School District for such injuries.

Lastly, if the above party has liability insurance for their organization, they will agree to add the Wautoma Area School District as an Additional Insured on their liability insurance, prior to the use of the facility.

Signature *
Please type in your full name as your signature.
Your answer
Date *
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