FACILITY USAGE REQUEST
*Facility use is limited by District and Room To Bloom usage and is limited to the specified building/area.
*As a general rule, facility usage is limited on Mon. - Fri. from 6:15 pm to 9:15 pm.
*Please fill out this form at least 14 days prior to the starting day of the event.
*Facility Rates and Fees apply. All invoices must be paid 5 business days prior to the start date of the event.
*Reservations will be voided if invoices have not been paid in full.
*The Facility Use Rules Regulations apply to all users and are available from each school office.
*You are responsible for your group and their actions.
*Children/Students must be supervised at all times.
*You are responsible for your group and their actions.
*Absolutely no alcohol, smoking, and/or "vaping" in any district area, facility or on school grounds.
REGISTRATION INFORMATION
Please be as detailed as possible!
Name: *
Your answer
Email: *
Your answer
Organization: *
Your answer
Address: *
Your answer
City: *
Your answer
State: *
Your answer
Zip Code:
Your answer
Home Phone: *
Your answer
Cell Phone: *
Your answer
FACILITY REQUESTS:
Availability based on district, RTB, and BC Rec Dept usage: M-F: 6:15-9:15, S-S: 9am-5pm
Sports Facility Requested: *
Required
ADDITIONAL ATHLETIC SPACE REQUESTED
Not all athletic facilities, room, or areas are available for public use. Alternative areas may be suggested.
Athletic Facility Requested (NOT LISTED ABOVE)
Your answer
BUILDING REQUESTS: CAFE, CONFERENCE SPACE, ETC
Availability based on district, RTB, and BC Rec Dept usage: M-F: 6:15-9:15, S-S: 9am-5pm
Building Requests: Cafe, Conference Space *
Required
ADDITIONAL BUILDING REQUESTS
Not all athletic facilities, room, or areas are available for public use. Alternative areas may be suggested.
Additional Building Request (NOT LISTED ABOVE)
Your answer
DATES REQUESTED
Please include all dates you are requesting, only enter dates in pertinent fields.
Reservation Date 1:
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Reservation Date 2:
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Reservation Date 3:
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Reservation Date 4:
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REOCCURRING DATES
Check/Choose All Days That Apply
Reoccuring Days:
Start Date:
MM
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End Date:
MM
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TIMES REQUESTED
HELP AVOID AND PREVENT OVERLAP: Requests should include a 15 minute transition time from the end of one facility usage to the start time of a subsequent request. i.e. if one group is scheduled to end at 7pm the next group should plan on using the facility at 7:15pm.
Program Begins At: *
Time
:
Program Ends At: *
Time
:
EVENT DETAILS
Please be as specific as possible
Number of Participants Expected *
Your answer
What will facility be used for? *
Your answer
Are the majority (51%) of your group Byron Center Public Schools Students/Residents? *
List appropriate equipment or special arrangements needed:
Your answer
Microphone: *
Sound System: *
Projectors *
Chairs: *
Estimated Number of Chairs
Your answer
Tables: *
Estimated Number of Tables
Your answer
Athletic Equipment Requested(Specify):
Your answer
RATES AND FEES
Information provided will help us determine the rates and fees assessed for the facility use request.
Do you live within the boundaries of Byron Center Public Schools (proof of residency required)? *
Will you charge an admission fee or make money for the event? *
IDENTIFY ASSESSED FEES
Please list any fees or charges which will be assessed to program participants
Per Person
Your answer
Per Group
Your answer
Other
Your answer
SPECIAL CONSIDERATIONS
Please list any special considerations that would impact your facility rental rate i.e. district athletic team, non-profit program, district event, etc. It is your responsibility to justify any shift from the facility usage outline.
Please list any special circumstances regarding your request:
Your answer
ACCOUNTABILITY STATEMENTS
It is the responsibility of the signee to comply with all BCPS rules and regulations. If there are any questions, it is the signees responsibility to communicate and find answers to these questions.
The undersigned is at least 21 years of age. He/She agrees to be responsible to the Board of Education for the use and care of school property and will be responsible for complete supervision of all parties in this activity. It is further agreed that the character of the facility use will conform to the Rules and Regulations governing the use of Byron Center Public Schools Facilities. *
The user agrees to defend, indemnify and hold harmless the School District, its boards, employees, and representatives from any and all claims, actions, suits, and judgments and expenses including claims, costs, attorney fees and damages in connection with its activities resulting in loss of life, bodily or personal injury, product liability claims and/or damage to property arising from or out of use by the User or its agents, members, partners, associates or employees, or any portion of the School District.
By signing this document, I agree to abide by all BCPS facility use rules and regulations. I will be responsible for any facility damage and the reimbursement to BCPS for the replacement of such equipment and/or facilities. My electronic signature indicates that I understand my responsibilities. I agree that If I need to change the date or cancel the request, I will email jrodriguez@bcpsk12.net 48 hours prior to my scheduled time of usage. *
Your answer
The User shall, at its own expense, keep in full force and effect until the cessation of its activity a commercial general liability (CGL) insurance policy having limits of not less than one million dollars ($1,000,000) for each occurrence and in the aggregate combined single limits for bodily injury, personal injury and property damage. In addition, the policy shall name the School District as an Additional Insured on the policy.
Date: *
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I understand that I will have to submit payment a minimum of 5 business days prior to requested usage. Failure to comply will result in cancellation of facility usage request. *
Required
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