USD 440 Facility Request Form

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Indemnity

As the requester, I represent myself, or the group for whom I am submitting this request, and agree to:

Indemnify and hold harmless, the District, its board, officers, directors, members, employees, agents, successors and assigns (collectively, the “School Parties” and individually, a “School Party”) from and against, and if requested, shall pay and defend, any and all claims, demands, liabilities, causes of action, damages, costs, or expenses (including reasonable attorneys and legal fees, costs of investigation and disbursements), and judgments made or incurred by or found against any School Party (all collectively “Losses”) resulting from or arising out of (a) any Losses or damages to person or property or claims therefore resulting to or arising from its use of District property or facilities by myself, or the group for whom I am submitting this request, or any individual granted access to the facility thereby, whether from an occurrence at the property or facility itself during such use, before or after such use, going to and from such use, in or about available parking areas or otherwise; (b) any damage to any District property as a result of access granted pursuant to this Agreement; or (c)any breach or default by myself, or the group for whom I am submitting this request or any other representation or warranty of said party under this Agreement, any term or provision of this Agreement, or the operation of the program or use of the facility.

By submitting this form I agree to the terms listed above.

Email *

Name of Organization, club, team: *

Name of requestor:* *

ADDRESS: *

PHONE NUMBER:* *

Which Building Are You Requesting *

Halstead High School

Halstead Middle School

Bentley Primary School

Outdoor

District Office

Requested Facility *

Auditorium

Main Gym

Aux Gym

Classroom

Commons/Lunch Room

Wrestling Room

District Stadium

Football Practice Field

HMS Small Practice Diamond

HHS Throwing Area

BPS Baseball Field

Disc Golf

Turf Baseball Field

Turf Softball Field

Baseball Cages and Bullpens

Softball Cages and Bullpens

Required

Specific Use (Activity Camp, Practice, Banquet)

Start Date:*

YYYY

End Date:* *

YYYY

Building Access Time:* *

Time

End Time:* *

Time

If these are regular meetings which reoccur throughout the school year, please indicate the specific dates and times: *

I have read the regulations which have been adopted by the Board of Education for the use of school buildings and agree that our organization will follow these regulations and will accept the responsibility as indicated. I understand facilities may not be available due to school functions or when school is not in session. I understand that the District has the authority to change the availability of the facility at any time. Outside organizations may be required a certificate of insurance at the time of application. I understand I may be asked to provide a roster of participants and their addresses. I understand priority will be given to school sponsored activities and activities that include a majority of district participants. I understand that by renting/utilizing the school facility, that the I and/or the party renting will abide by and follow all district policies and procedures. *

I understand and agree with the terms laid out in this form.

Submit

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