RESC Facility Use Request form
By completing and submitting this form, we agree to be responsible for any accidents or injuries sustained by any person attending or participating in the program or activity for which we may use the requested facilities, and to be responsible for replacement in case of any damage or loss incurred. Further, in accordance with State requirements and Board policy, we agree that there shall be NO USE OF TOBACCO OR CONTROLLED SUBSTANCES ON SCHOOL PROPERTY.
Name of Organization
Your answer
Mailing Address
Your answer
Responsible Party
Your answer
Contact Phone
Your answer
Facility Requested
(be specific: building, room, area(s), etc. If requesting cafe/kitchen, please contact the cafe manager at 765-964-4994 ext. 140)
Your answer
Reason for Request
Your answer
Beginning Date Required
MM
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DD
/
YYYY
Ending Date Required
MM
/
DD
/
YYYY
Event Beginning Time
Time
:
Event Ending Time
Time
:
Set-up Time Begins
Time
:
Clean-up Time Finished
Time
:
Equipment Required
Your answer
Staffing/Other Items Required
Your answer
Agreements:
Please click in each box below showing agreement to each of the requirements:
E-mail address
Please enter your email address to receive a copy of this request.
Your answer
Today's Date
MM
/
DD
/
YYYY
Submit
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