PACS Facility Use Request Form
Please submit this form electronically only. Non-school organizations must submit a current certificate of liability insurance upon approval. The school will contact you with your approval, rejection, or any questions.
Which building are you requesting? *
Required
Contact name of the organization or individual requesting use? *
Your answer
Contact email address and/or phone number *
Your answer
Which room(s) are being requested? *
Your answer
What is the purpose of requested facility use? *
Your answer
How many participants are expected? *
Your answer
What is the date(s) of requested facility use? Please type as MM/DD/YY *
Your answer
Setup Time *
Time
:
Event Time *
Time
:
Cleanup Time *
Time
:
What equipment, if any, is being requested for use? Examples: sound and lights in auditorium, tables in the cafeteria, pool equipment, podium with microphone, projector and screen, etc. Some equipment requests will require orientation for the requestor by school district staff.
Your answer
Will you need technology/IT support? Please describe the help you will need if applicable.
Your answer
Terms and Conditions
The requestor is over 21 years of age and has read this form and attached Facilities Use Regulations and agrees to comply with them. He/she agrees to be responsible to the Pulaski Academy and Central School District for the use and care of the facilities. He/she on behalf of the organization or individual requesting use, does hereby consent and agree to defend, indemnify and hold harmless the Pulaski Academy and Central School District from and against any and all liability, loss, damages, claims, or actions (including costs and attorney’s fees) for bodily injury and/or property damage, to the extent permissible by law, arising out or in connection with the actual or proposed use of Pulaski Academy & Central School District’s property, facilities and/or services by the organization or individual requesting use.
I agree to the Terms and Conditions set forth. *
Facilities Use Regulations
The use of all District facilities shall be subject to the approval and rules of the Board of Education and administered by the Building Principal or other Board designee.

1. Organizations wishing to use District facilities shall first apply using the prescribed form.
2. Facilities are not available if in conflict with school use.
3. Organizations must follow District Food Allergy Guidelines: no tree nuts or peanuts may be eaten in district schools outside of school cafeterias during scheduled lunches, and faculty/staff break rooms.
4. In the event of inclement weather, the District has the final authority on whether facilities are usable.
5. The fee for use, if appropriate, is payable before use begins. Weekend hours maybe subject to an hourly rate.
6. All posted rules must be adhered to.
7. Profanity, objectionable language, disorderly acts or illegal activities of any kind are absolutely prohibited.
8. Alcohol, drugs, and all tobacco products are prohibited on District property.
9. No unauthorized vehicles are allowed on school property. No field or building alterations (lining of fields or gymnasiums, erecting permanent goal posts or structures, etc.) are allowed without prior approval.
10. Organizations using the facilities must clean up afterwards.
11. Any organization with youth under 18 years old requires the presence of adequate adult supervision at all times.
12. Any damage to District facilities shall be promptly repaired at the user’s expense.
13. Permits may be revoked at any time.
14. Prior to the start of the event, an announcement should be made to your group regarding emergency evacuation procedures. For example, pointing out posted procedures, directions for exiting, how to respond to a fire alarm, etc.
15. The District does not discriminate on the basis of race, color, national origin, physical impairment or sex in its educational programs or employment services.
16. If the facility is used when no custodial staff is on duty, the organization will be responsible for the custodial staff wages for the time on duty.
17. All users must provide the following insurance prior to using the facilities. Failure to do so prior to use will result in revocation of your permit.
• The user hereby agrees to name the District as an unrestricted additional on the user’s policy.
• The policy naming the District as an insured: shall be an insurance policy from an A.M. best rated “secured” NYS licensed insurer; contain a 30 day notice of cancellation; shall state that the organization’s coverage shall be primary and non-contributory coverage for the District, its Board, employees and volunteers. Additional insured status shall be provided with ISO endorsement CG 20 26 or its equivalent.
• The user agrees to indemnify the District for any applicable deductibles and self-insured retentions.
• Required Insurance: Commercial General Liability Insurance, $1,000,000 per occurrence/$2,000,000 aggregate.
• User acknowledges that failure to obtain such insurance on behalf of the District constitutes a material breach of contract and subjects it to liability for damages, indemnification and all other legal remedies for the District. The user is to provide the District with a certificate of insurance and additional insured endorsement, evidencing the above requirements have been met. The failure of the District to object to the contents of the certificate or the absence of same shall be deemed a waiver of any and all rights held by the District.

The District is a member/owner of the NY Schools Insurance Reciprocal (NYSIR). The user further acknowledges that the procurement of such insurance as required herein is intended to benefit not only the district but also the NYSIR, as the District’s insurer.
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