Facility Use Request
Your Name
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Email Address
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Mailing Address
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Contact Phone Number
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Facility Requested
Room Requested
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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
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Event Start Time
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Event End Time
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More Date / Time Info
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Public Event
Level
Purpose / Type of Activity
Your answer
Special Equipment Required (Chairs / Tables)
Your answer
Estimated Attendance
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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
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Your answer
Date
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