Building and Sites Use Form

Policy Title:  Community Use of School District Facilities and Equipment Application Form           

 Code No. 905.1E1

The undersigned entity makes application for the use of the school district facility or equipment as designated below. The entity may be required to tear down and/or set up the area they are requesting to use. The entity will provide supervision and police protection at its own expense, if necessary, to maintain order and to properly protect the facility, site, or equipment.

Please refer to Policies 905.1 and 905.1R1 to determine the proper use of school facilities, sites, and equipment. Refer to Policy 905.1R2 for building, site, and equipment fee schedule. And refer to Policy 905.1R3 for ICN room use.  

All of these policies can be found on the school website under District and Board Policies. 

The entity will be required to provide an Indemnity and Liability Insurance Agreement, Policy 905.1E2, prior to the use of school district buildings, sites, or equipment.

Sign in to Google to save your progress. Learn more
Building/Site/Equipment Requested:  *
Date(s) needed: 
 *
Purpose for using:
 *
Hours needed:
 *

Do you plan to charge admission/fee and/or make a profit from this usage? Yes or no

 *

Please check all that you will be using in the gymnasium

 *
Required

Classroom/ICN

 *
Required

Custodial and/or Kitchen Supervision Requested (requested hours X hourly rate person)

 *
If Custodian or Kitchen staff are needed how many hours? *
Name of Entity making application *
Contact Person for Entity
 *
Contact Phone Number *
By signing this Electronic Signature Acknowledgment Form, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.
 *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Osage Community Schools.

Does this form look suspicious? Report

Google Forms