Application for Use of School Facilities
Medway Public Schools
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Email *
Name and Type of Organization, a(n) individual corporation, etc. *
Mailing Address (for billing purposes): *
Contact Person's Name: *
Contact Person's Title (if any):
Telephone: *
Email address: *
If activity must be cancelled by School Department, who (if different from above) should be contacted? Note - all activities are generally canceled whenever school is closed due to inclement weather. Please provide name and cellphone of contact. *
Please describe activity/name of event: *
Name of event: *
Date(s) of event: *
Time of event (please include beginning and end time): *
Facilities needed: (please check all that apply) *
Number of rooms and/or other rooms please specify: *
Equipment needed: (please check all the apply) *
Amount of equipment and/or special setup? *
Will your event be open to the public? *
Approximate number of expected attendance? *
Number of chaperones? *
Has your organization previously used Medway Public Schools facilities? *
Is your organization an agency of the Medway government? *
If the last answer was no to the last question, a Certificate of Insurance must be filed with the Business Office two weeks prior to the planned event. Insurance must have minimum limits of $1,000,000 for general liability (covering bodily injury and property damage combined, and personal injury). The Certificate of Insurance must include the Town of Medway as additional named insured.
It is understood through the submission of this application and the user is solely responsible for the fulfillment of the following regulations that: *
I have received and read the Fee Schedule (or fee estimate), if applicable: *
I received and read the Auditorium Usage Addendum, if applicable: *
By signing this document, I hereby declare compliance with Title IX, outlined by the Medway School Committee, which states: It is policy of Medway Public Schools not to discriminate on the basis of sex in its educational programs, activities or employment policies required by Title IX of the 1972 Educational Amendments. Inquires regarding compliance with Title IX may be directed to the Office of the Superintendent, Medway Public Schools, 45 Holliston Street, Medway, MA 02053; or the Director of Civil Rights, Boston, MA.
By typing your name I hereby accept responsibility for supervision, compliance with applicable laws, regulations and Medway School Committee policies, and payment of fees (if applicable, and subject to additional assessment in the event of damages) associated with the foregoing use of school facilities. Please note: The use of School Committee, and the district reserves the right to cancel any contract.
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