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Community Facilities Request Form (Not For Teachers or Staff)
This Form is NOT to be used for Scheduling Elementary Labs 1, 2, or 3, contact Kristi Surfus (Unless event is after school hours).
Nor is to be used for requesting the Gyms, please use the Athletic's Request Form.
Prior to completing this document, please review the following information located on this website at: ABOUT GKB CSD>Facilities>Facility Usage Policies
Event Title *
Please enter the title of your event.
Requester's Name *
Please Enter Your Name
Requester's EMAIL *
Name of Club or Organization *
Which facility is being requested? *
Please select from below
Type of Organization: *
Please select from below
Number of Attendees (if known) *
Please list how many will be attending
Date(s) of Event *
MM
/
DD
/
YYYY
Set- up time starts at...
(This is when you will need to get into the building to prepare for event)
Time
:
Event begins at...
(This is when participants will show up for the event)
Time
:
Event ends at...
(This is when the official event will be over)
Time
:
Take-down and clean up ends at...
(This is when you will be completely done and leave the facilities)
Time
:
(For multiple-day events) Please list out set-up, event beginning and ending times, and final end times for each day
Other special requests... *
(These may or may not be available, but will try to accommodate) - (If Doors Unlocked is selected, please indicate below in "Other" which doors are to be opened and at what times)
Required
Other......
Which Doors need to be unlocked and at what Times
Will Custodial Services be needed? *
If a Custodian is NOT needed
It is assumed that you have keys to unlock doors & turn on lights
If a Custodian is needed, how many will be needed?
Please enter the number of Custodians
Estimate number of hours for Custodial Services
Please indicate arrival time for Custodian and if they are needed for duration of event?
Will Food Services be needed? *
Estimate number of hours for Food Services
Will Light/Sound Services be needed? *
Estimate number of hours for Light/Sound Services
Will Additional Equipment be needed? *
If Additional Equipment is needed (Please Specify)
Number of tables (if needed): *
Please enter the number of tables you would like to have set up
Number of chairs (if needed): *
Please enter the number of chairs you would like to have
Set-up Instructions (Please Specify)
In Case this Event needs to be Cancelled, please notify:
Acknowledgment
Request for use of facilities should be made as much in advance as possible, with a minimum of seven days preceding requested use. This request will be reviewed as to available facilities and confirmed as quickly as possible. The organization named above will be held liable for damages to school building, facilities and / or equipment beyond normal wear and tear. NO SMOKING IS PERMITTED IN SCHOOL FACILITIES OR ON SCHOOL GROUNDS. The Board of School Trustees of the Garrett-Keyser-Butler Community District requires that the rental of facilities other than school affiliated groups submit a $1,000,000.00 Certificate of Liability Insurance for the protection of itself and the school corporation for the period of use herein established and name Garrett-Keyser-Butler Community School District as an additional insured. A copy must be provided in advance. The organization named above shall relieve and shall hold harmless Garrett-Keyser-Butler Community Schools and all of its employees or agents from any and all responsibility in regard to liability for bodily injury, property damage, and product liability of any kind during the period of use herein established. The organization named above hereby agrees not to hold any activity deemed to be objectionable as determined by the values of the community or to create a public disturbance. Groups required to pay will be charged a $50.00 deposit (refundable) is required to hold the facility. This will be applied to the total cost of the facility. Person(s) held responsible (must be at least 21)
Mailing Address
I acknowledge that I have read and understand GKB Board Policies 7510 and 7510.01 and Administrative Guidelines 7510.
Signature of Person Responsible
Telephone Number
Date Signed
Submit
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