Facility Usage Request Form

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Clinton County Showcase *

Melissa Mueller *

muellermelissa213@gmail.com *

PO Box 163/Breese IL, 62230-0163 *

6183348331 *

June 14th-June 28th, 2026 *

YYYY

Rehearsals 6/14-6/24 on will be about 6:00-9:30 PM on weeknights, loading in the set will probably start around 10:00 AM and end no later than the late afternoon on Saturday the 20th, we may bring costumes on 6/19 and/or 6/21, performances June 25th-28th 5:30-10:30 PM Thurs-Sat and 11:30 AM-9:00 PM on Sunday *

Time

Finding Nemo Jr. Rehearsals, Set Load In, Performances, and Set Take Down *

For the areas of the facility to be used, we should just need the commons area, stage, nearest bathrooms, and main gym for our cast, crew, and audience. We will be selling concessions, so we may need the kitchen depending on where we have to make popcorn. *

If Other, please explain

As far as special usage, we will be using as much of the stage technical equipment that Central can provide. In the gym, we were hoping to put down mats for the areas kids are walking on if allowed. This will help us decrease the sound of people walking in the gym during the show. No problem if we can't!

We expect to sell out based on audience numbers from year's past, so we will be at the 330 person capacity. *

We will be charging admission on the CCS website and at the door. *

If YES, please list amount of Admission Charge for the event - We are charging $12 per ticket.

Special Equipment Needed (Please check all that apply) - we should just need the sound system, AV equipment, and possibly the popcorn machine at Central. We can bring our own machine if needed. *

Option 1

Required

Custodial Services Needed (Please Describe Specific Needs) - We will clean up after ourselves every night, so this shouldn't be needed. *

Safety and Security Guidelines: All parking of vehicles for events must be in the student parking lot to the southwest of building and access made through student (west) entrance of the facility unless otherwise directed by school personnel. The organization may be asked by the administration to provide a list of potential attendees and workers for the event at least twenty-four hours in advance. Once at the school, access to all other areas of the facility is strictly prohibited without approval by school personnel. All areas of the facility should be closed, locked, and returned to previous condition when activity is concluded. If members of the organization view any activity or situation of a suspicious or dangerous nature, a representative must contact law enforcement and/or school personnel immediately. *

I have read and agree to the Safety and Security Guidelines - Yes I have read and I agree to the safety and security guidelines.

Fees and Expenses: It is to be understood and agreed that additional personnel required for the event (i.e. custodians, etc.) and other costs incurred by the school district will be paid for by the organization as a fee charge. In addition, the organization agrees to be fully responsible for the building and equipment during the duration of usage. Any damages incurred during the usage of the facilities will be the responsibility of the organization. Adult supervision must be provided by the organization and the organization must enforce all policies and regulations as set forth by the Board of Education and Administration. *

I have read and agree to pay any Fees and Expenses - Yes we will pay if this is needed.

Yes

Waiver of Liability: Central Community High School shall be indemnified and saved harmless by the organization using the facilities listed above from any and all claims of every character or nature arising out of or resulting from the use of said facilities. (The organization may be asked to provide the district with a certificate of insurance.) *

I have read and agree to the Waiver of Liability for Central Community High School - Yes we have read and will uphold the Waiver of Liability.

Yes

Signature of Individual Representing the Organization (*A copy of this form will be returned to organization with approval or denial of usage as designated.) *

Date of Request June 4th, 2026 *

YYYY

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