Salisbury Township School District Application for Usage of Facilities
Liability insurance naming Salisbury Township School District as additional insured for up to 1 million dollars must be provided for classifications B-C-D. Please read our Board Policy 6B.3 Use of Facilities at


The undersigned hereby makes application for use of school facilities as follows:
Please choose classification *
Name of organization: *
Purpose of facility request:
Building Requested *
Dates facility is needed (list all dates!) *
Times facility is needed (list start AND approximate ends times for EACH date) *
Facilities requested (*requires cafeteria worker-see below): *
OTHER: Complete this field if selecting Classroom or Athletic Field above
Staff requests: *
State specific purpose of staff need. Be complete.
Will admission fee be charged? *
If an admission fee is being charged, what will it be?
Equipment requested (*must be operated/provided by school personnel)
Explain details of equipment requested:
Additional instructions or comments:
List name, address and phone number for two responsible officials. One official must be present at the time facilities requested are being used and must accept full responsibility for adherence to school district regulations.
Official #1: *
Official #2: *
Official #1 listed above: I/we agree to the terms/conditions listed below
Clear selection
Official #2 listed above: I/we agree to the terms/conditions listed below
Clear selection
I/We certify that I/we have read and understand the regulations of the Salisbury Township School District concerning the use of school buildings and further, that I/we forever release the Salisbury Township School District, its directors, agents, and employees from all claims, actions, and charges whatsoever arising out of the event(s) conducted on the above-mentioned date(s) for which this application is submitted. Upon prompt notice I/we will defend all actions, suites, complaints, or legal proceedings of any kind brought against the Board of Education and any of its agents or employees and further, it will hold harmless and indemnify the said School Directors and School District, from any expenses and judgments or decrees recovered against them as a result of the said use of these facilities.
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