Athletic Facilities Request Form (Community)

Event Title

Please enter the title of your event.

This is a required question

Requester's Name

Please Enter Your Name

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Requester's EMAIL

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Name of Club or Organization

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Which facility is being requested?

Please select from below

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Type of Organization:

Please select from below

This is a required question

Number of Attendees (if known)

Please list how many will be attending

This is a required question

Date(s) of Event

Set- up time starts at...

(This is when you will need to get into the building to prepare for event)

:

Event begins at...

(This is when participants will show up for the event)

:

Event ends at...

(This is when the official event will be over)

:

Take-down and clean up ends at...

(This is when you will be completely done and leave the facilities)

:

(For multiple-day events) Please list out set-up, event beginning and ending times, and final end times for each day

This is a required question

Will you need the bleachers pulled out for seating?

If Yes, please answer bleacher question below

Yes
No

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Do you need all the bleachers or only one side pulled out?

Also, please indicate which side should be pulled out

This is a required question

Additional Tables (if needed):

Example: Scorer's Table, etc. Please enter the number of tables you would like to have set up

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Number of chairs (if needed):

Please enter the number of chairs you would like to have

This is a required question

Other......

Which Doors need to be unlocked and at what Times

This is a required question

Will Custodial Services be needed?

If Answered "NO", you must provide the name of school employee taking responsibility with their contact information

This is a required question

If a Custodian is NOT needed

It is assumed that you have keys to unlock doors & turn on lights

This is a required question

If a Custodian is needed, how many will be needed?

Please enter the number of Custodians

This is a required question

Estimate number of hours for Custodial Services

This is a required question

Will Food Services be needed?

Yes
No

This is a required question

Estimate number of hours for Food Services

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Will Light/Sound Services be needed?

Yes
No

This is a required question

Estimate number of hours for Light/Sound Services

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Will Additional Equipment be needed?

Yes
No

This is a required question

If Additional Equipment is needed (Please Specify)

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Set-up Instructions (Please Specify)

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In Case this Event needs to be Cancelled, please notify:

Chris DePew - - chrisdepew@gkb.k12.in.us - - 260-357-4116
Becky Blotkamp - - bblotkamp@gkb.k12.in.us - - 260-357-4116
Tonya Kelham - - tkelham@gkb.k12.in.us - - 260-357-3185
Billy Pogue - - bpogue@gkb.k12.in.us - - 260-357-7007

This is a required question

Acknowledgment

Request for use of facilities should be made as much in advance as possible, with a minimum of seven days preceding requested use. This request will be reviewed as to available facilities and confirmed as quickly as possible. The organization named above will be held liable for damages to school building, facilities and / or equipment beyond normal wear and tear. NO SMOKING IS PERMITTED IN SCHOOL FACILITIES OR ON SCHOOL GROUNDS. The Board of School Trustees of the Garrett-Keyser-Butler Community District requires that the rental of facilities other than school affiliated groups submit a $1,000,000.00 Certificate of Liability Insurance for the protection of itself and the school corporation for the period of use herein established and name Garrett-Keyser-Butler Community School District as an additional insured. A copy must be provided in advance. The organization named above shall relieve and shall hold harmless Garrett-Keyser-Butler Community Schools and all of its employees or agents from any and all responsibility in regard to liability for bodily injury, property damage, and product liability of any kind during the period of use herein established. The organization named above hereby agrees not to hold any activity deemed to be objectionable as determined by the values of the community or to create a public disturbance. Groups required to pay will be charged a $50.00 deposit (refundable) is required to hold the facility. This will be applied to the total cost of the facility. Person(s) held responsible (must be at least 21)

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Mailing Address

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I acknowledge that I have read and understand GKB Board Policies 7510 and 7510.01 and Administrative Guidelines 7510.

Signature of Person Responsible

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Telephone Number

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Date Signed

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Accept or Rejection

Chris DePew
Becky Blotkamp

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