SCS Building Use Form
Organization or Event Name
Phone Number(s) Where You May Be Reached
Number of people using the space:
1 - 5
6 - 10
11 - 25
Check all that apply
Projector & White Screen
Date of event
For multiple dates, please scroll down to "Other Pertinent Information"
Multiple Dates Requested
List more dates for above listed activity
What area/classroom are you requesting?
please list all that apply
select best option
15 minutes before/after
30 minutes before/after
1 hour before/after
"For Fee" Activities are subject to either a 25% building use charge which provides user with registration, payment collection and processing, room set-up if required and custodial service or a 10% fee which is used for building/custodial service. Please indicate below which service applies.
External Use/Full Service 25% Fee Applies
External Use/Custodial Service Only 10% Fee Applies
Internal Use Only/No Fee Charged For Program
I have read the following building use information.
Building Use: For Your Information Shelburne Community School welcomes and encourages after-hours use of the building and grounds. Because uses are many and varied, the following criteria have been created so that building maintenance/cleaning and upkeep may be facilitated in a timely manner, while maintaining and respecting the daily use of the facility’s primary use of educating Shelburne’s wonderful student population. Please make sure to fill out either an external or an internal building use form (internal form found under “staff and students” on the scs homepage, external use form found under “school Information” also on the scs homepage). Please do a brief visual inspection upon arrival in the area/classroom to ensure that area is left the way it was found. Familiarize yourself (and other leaders) with emergency procedures and map (located on the wall of each classroom/kiva noting where building exits are. NOTE: During a fire alarm, all building occupants are to take the closest exit and make their way to the basketball court (by Harbor Road entrance). Adults responsible for each group/student(s) should have a list (clipboard is suggested) of students, including their names and contact information of their parents which they bring along so that each student may be accounted for in a timely manner. During an “intruder alert”, an announcement will be made stating: “Clear the halls. Secure the building” This announcement will be repeated once. Each responsible adult should exit with students as quickly as possible if an exit door exists IN THE CLASSROOM. If exit door is used, please locate students to the nearest safe building (home) and call 911. If no outdoor exit is easily accessible, keep students where they are. Lock the door if you have one, turn off all lights, and have everyone hidden as well as you are able until all clear is announced. In case of an accident or illness (ex. cut finger, vomit), custodian should be contacted immediately for cleanup. AVOID ANY PHYSICAL CONTACT with bodily fluids. All school materials (papers, student work, cubby notebooks, etc) must be treated as private and confidential. No students or adults should ever go through a student’s or teacher’s materials.
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