Independent School District 197: Facility Usage Permit
Community Education Facility Usage
1897 Delaware Ave
Mendota Heights, MN 55118
Email: jessica.cervantez@isd197.org
General Conditions for Rentals
a. The sponsoring head of the group or organization using facilities must be present to supervise.

b. A certificate of liability will be required from applicants who will use school facilities for fundraising activities, profit or commercial gain.

c. Applicants must exercise the utmost care in the use of school premises and agree to protect, indemnify and hold harmless Independent School District 197 and its officers, agents and employees from any and all claims,liabilities, damages or rights of action, directly or indirectly, growing out of the use of the premises covered by the permit if insurance is required.

d. Use of auditorium equipment requires 2 Sound & Lighting technicians to be present. (Additional Charges Apply)

e. A food service employee must be present when the use of the kitchen is requested. (Additional Charges Apply)

f. Use of facilities is limited to 4:00-9:30 p.m. (Classrooms) 7:30-9:30 p.m. (Gyms) on weekdays, and 8:00 a.m.-9:30 p.m. weekends (All Spaces).

g. When custodial fees are applicable, the custodial overtime fee of $35/hour will be applied thirty-minutes prior to your set-up time and thirty-minutes after your tear-down time.

h. A $20.00 filing fee will be billed to you after your event is approved.

i. For all pool rentals, one lifeguard per 15 swimmers will be assigned at a rate of $14 per hour. Minimum two lifeguards required. (Additional Charges Apply)

j. Return room to the original layout.

k. A 15.00 charge is incurred for every change made to your existing permit. Please choose your dates wisely.
Organization Information
Organization Classification *
Name of Organization *
Your answer
Address of Organization *
Your answer
Contact Person Information
This person will be responsible for all charges associated with this rental.
Contact Person Name *
Your answer
Contact Phone Number *
Your answer
Contact Email *
Your answer
Approximate. Age of Participants Using Space *
Your answer
Tax Exemption Status *
If claiming non profit status, be prepared to provide proof
Insurance Company Name and Policy Number *
Dates valid
Your answer
Event Information
Name of Event *
Your answer
Building *
Room/Field *
Your answer
Date(s) of your event - Please list all dates needed *
Your answer
Set-Up Time *
This is the time you will enter the building to begin set-up for your event.
Time
:
Event Start Time *
This is the time when your event will begin.
Time
:
Event End Time *
This is the time when your event will end.
Time
:
Tear-Down Time *
This is the time when you will be leaving the building.
Time
:
Approximate Number of Attendees *
Your answer
Equipment Needs *
Please be as specific as possible (ie: tables, chairs) and is only subject to availability.
Your answer
Applicant Signature
I hereby certify that I am an agent of the named organization and have been authorized to accept in their name the responsibility of the rules and regulation put forth by the Independent School District 197 School Board. I further certify that I have read and understand the general rules and regulations for facility use. I have provided a certificate of insurance evidencing liability coverage. I understand that this permit may be revoked or canceled by the school district at any time with or without cause. I understand that issuance of a permit will be the official indication that the space is reserved. The permit will also indicate, if applicable, rental costs. Final billing, of actual costs, will be forwarded to the undersigned and payment must be made within 10 days of receipt. The undersigned agrees to defend, indemnify and hold harmless the school, its agents and employees from any and all claims, losses arising directly or indirectly out of the use by the undersigned of the school’s facilities.
Signature *
By typing your name you are agreeing to the content of this request form.
Your answer
ALL REQUESTS MUST BE RECEIVED BY THE COMMUNITY EDUCATION OFFICE AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT. CHANGES TO THIS EVENT WILL INCUR A 15.00 CHARGE PER CHANGE.

A permit request does not guarantee your reservation. You will receive notification from Community Education staff regarding this request.
Submit
Never submit passwords through Google Forms.
This form was created inside of TriDistrict Community Education.