Facility Use Application
Sign in to Google to save your progress. Learn more
Name/Organization making application *
Phone: *
What day and time would you like the facility?  Do you want the facility on a regular basis?  If so what dates and times do you want it. *
Please include day(s), time(s) in and out and how often you want it.
Facility you desire to rent: *
Non-profit groups (Those that do not charge admission/entry fee into their event) shall be free of charge.  A $100 security deposit will be required for non-profit groups.  Deposit will be returned after event is held and no damages have occurred.  Profit groups (Those that charge admission/entry fee into their event).                                                                                *Concession stand and equipment are not available for use or rental. Groups intending to sell concessions should work with the District designee for acceptable location(s) and electrical limitations. Additional Fee may apply.*Use of supplies and damages will be billed on a 100% replacement cost basis.*Requests for equipment or items not listed on the above fee schedule should be arranged prior to arrival with the District designee and may involve an additional fee not listed above.
What will take place during the activity? *
Does the group holding the activity or individual(s) sponsoring the activity have liability insurance? *
What is the name of the insurance agent?
What is the name of the insurance company?
Sponsor's Duties and Responsibilities
1.School groups shall always have first priority for facility usage.

2.Religious organizations may use facilities for religious purposes only on anemergency basis, and must be in the process of securing other facilities for theirpurposes.

3.One individual from the group using the facilities shall be designated as coordinatorto communicate with the Activities Director with regard to the activity. All groupcommunications will be coordinated through this individual.
a.The coordinator must be over 21 years of age.
b.He/She shall be in charge of the opening of the building, the supervision of thebuilding, and the securing of the building.

4.Alcoholic beverages are prohibited on school property.

5.Smoking is prohibited on school grounds at all times.

6.The district is held harmless for all material and personal damages or losses.

7.Users are responsible for all damages during use. Damages will be assessed by theSuperintendent.

8.The Board reserves the right to not approve any rental that may be in conflict withgeneral school purposes, may be hazardous to the building or those involved orcauses excess liability hazard.

Submission of this form shows understanding and agreement of all sponsor duties and responsibilities.
Clear form
Never submit passwords through Google Forms.
This form was created inside of Shelby Public Schools. Report Abuse