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Facility Use Form
*Required form for consideration of Knoxville Community School District facility use.
*Liability insurance is required to rent school facility. [Requirements: $1 million (minimum) liability as well as list KCSD as an additional insured.]
*Please allow at least two business days for a response to all facility use requests.
Checklist prior to completing this form
1. Read Board Policies 908 and 909 (linked below) prior to submitting this form. *Liability Insurance is required to use KCSD facility (specific policy needs: minimum liability limit of $1 million and Knoxville Community School District as additional insured.)
2. Read all questions of this request form before entering your answers.
3. Please gather a roster (expected attendees- adults and/or youth) to be emailed after the submission this form.
Organization or Group Name *
Is your organization affiliated with Knoxville Schools? *
Many activities/sports exist that encourage KCSD and other area youth to be involved with the goal/hope of encouraging them to participate in District-Sponsored Organizations in the future, but these organizations are not tied to the District in any other way. (Note: Knoxville School activities and events take priority in all facilities.)
I agree to using KCSD facilities as outlined in Board Policy 908* (Community Use of School District Buildings, Sites and Equipment). *Facility rules, regulations and fees are listed in this policy for your convenience. *
I agree to using KCSD facilities as outlined in Board Policy 909* (Use of School District Facilities Regulation). *Facility rules, regulations and fees are listed in this policy for your convenience. *
Place of Meeting/Event *
Check any preferred location.
Required
Purpose of Meeting/Event *
(Type of Activity, Event or Sport)
Roster *
Please list your roster (including all adults & children involved)
Expectations *
Please list your expectations of the organization/team that you represent and are requesting use of a KCSD facility for.
Date(s) Needed *
Please note: The form allows for multiple dates with the SAME start and end TIMES. If you have varying start times, use separate (additional) forms. Examples: Practice 7:00 pm on 5 consecutive Mondays --- One Form. Practice 5:00 pm on 2 Mondays and 3:00 on Tuesdays --- Two Forms
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Additional Date (2)
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Additional Date (3)
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Additional Date (4)
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Additional Date (5)
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If more than five dates are needed please list here. (mm/dd/yy format)
Please provide any additional information that may be helpful in scheduling a facility for your organization. Is there anything else we should know?
(additional event details)
Start Time (When the building needs to be ready including prep time) *
Time
:
End Time *
Time
:
Will you be serving food? *
Required
If you are serving food, please describe.
Will you require any special equipment? *
Required
If you are requiring any special equipment, please describe.
Chairs (#), Tables (#), Sound system, Projection system, Specify stage equipment, Podium, Food Service Equipment
Do you have any questions? Other details? Please note here.
(additional event details)
Contact Name *
Contact Email Address *
Contact Phone Number *
Alternate Phone Number
*
(Specific policy needs: minimum liability limit of $1 million and Knoxville Community School District listed as an additional insured.) Additional space below is provided for additional information you wish to provide.
For Office Use Only
Rental Charge:

Other Charges:

Reasons for Other Charges:

Custodians Assigned:

Cooks Assigned:

Complaints, Damages, Problems Reported:

Date Fees Paid:

For Custodian Use Only
Actual time the building was used by the Groups or Individual ________ to ________ Total Time ________

Total Time Worked at the Event ________ including preparation and cleanup.
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