Use of Facilities Request for Middle School
Email address *
Name of Requestor *
Mailing Address of Requestor *
Phone Number of Requestor *
Name of Activity *
Organization *
Start Date Facility Needed *
Please list the start date the facility will be needed. When choosing a date range, please fill out additional facility requests for a random day during the requested time. (example: If you request every Sunday for the month and a random Wednesday, fill out 1 request for the Sundays and 1 request for your Wednesday.)
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DD
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YYYY
End Date Facility Needed *
Please list the last day the facility will be needed. Please list the same date as the start date if it is only required for one day.
MM
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DD
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YYYY
Times Facility Needed *
Please list the times that the facility will be needed. Example: 7 pm to 9 pm each day.
Admission Charge *
Building/Room/Facility Requesting *
* When the kitchen is used, a cook must be present for which a fee of $20/hour will be charged. **When an Organization rents a facility and it is necessary for a custodian to be present, a $20/hour fee will be charged. ALL FEES DUE PRIOR TO USE OF FACILITY.
Additional Information *
Please provide if any special equipment is needed or relevant information for the request.
Principal's Approval (not to be filled out by requester)
Superintendent's Approval (not to be filled out by requester)
Rental Fee Waived - (filled out by Board Clerk)
Clear selection
Amount Due (filled out by Board Clerk)
Date Available (filled out by Building Secretaries)
Clear selection
On Calendar (filled out by Building Secretaries)
Clear selection
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