CMHS Facility Use Request
Email address *
Name of Organization *
Your answer
Description of event *
Your answer
Start Date of Activity *
MM
/
DD
/
YYYY
End Date of Activity *
MM
/
DD
/
YYYY
Time Enter/Setup *
Time
:
Start Time of Activity *
Time
:
Exit time of Activity *
Time
:
Approximate Expected Number in Attendance *
Your answer
Type or Nature of Activity *
Building Requested *
Area To Be used *
Notes
Your answer
Purpose of Activity *
Required
For whom or what will proceeds be used? *
Your answer
List Equipment Needed
Projector, Screen, PA System, Chairs, Tables. Be specific.
*
Your answer
The following conditions and/or charges may apply:
1. A district kitchen employee must be present during use of kitchen facility.
2. If custodial services exceed normal daily duties for any district facility a charge may be levied.
3. Auditorium lights and sound system may only be used by trained personnel, and a charge may be applied.
Organization using the requested facility is responsible for clean up and any damage.
Final approval will be given by the district administration.
The individual submitting this request and the organization represented agrees to hold the School District and related personnel harmless from any physical damage or personal injury that may occur due to the use of District property.

Keys may be picked up, following final approval, the last working day before the requested activity. Keys must be promptly returned.
Final approval will be emailed to the person listed below.
Please provide contact information below. By submitting this request, you are acknowledging approval of all of the terms and conditions for facility usage by the Clatskanie School District.
NAME *
Your answer
EMAIL ADDRESS *
Your answer
PHONE NUMBER *
Your answer
MAILING ADDRESS
Your answer
A copy of your responses will be emailed to the address you provided.
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