Outside Organization Equipment and/or Facilities Use Request
**School Equipment and Building Use Request(s) must be submitted to the Facilities Director or School building principal no less than two weeks prior to the date of the equipment use or event date.**
Email address *
Your answer
Contact Person *
Your answer
Date of Request *
MM
/
DD
/
YYYY
Contact Person Phone # *
Your answer
Address of Contact *
Your answer
Organization *
Your answer
Date(s) of Activity *
Include start and end date if recurring
Your answer
Series of Day(s) *
Check all that apply
Required
Recurring Activity (if applicable)
Check all that apply
Activity Name *
Your answer
Building to be used *
Required
Area/Room to be used: *
Your answer
Additional Notes
*** Fitness Room Requires Additional Release Form***
*** Students must have adult supervision for both set up and cleaning up.***
*** Chaperones: High School Dances must have at least five chaperones, including a minimum of two males and two females***
Actual Activity Hours
Your answer
Actual Time in Building (am/pm) *
Your answer
Actual Time Out of Building (am/pm) *
Your answer
Total participants expected(Adults/children):
Your answer
Is there a setup diagram?
Is this a school sponsored activity?
If yes, name of school trained person for AED
Your answer
Is an admission fee charged?
If yes, what are the proceeds used for?
Your answer
Will you be using the school kitchen?
Are refreshments being served? If yes, give details
Your answer
Is any other equipment requested?
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