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CCSD Facility and Service Request Form
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* Required
Name
*
Your answer
Email
*
Your answer
Organization
*
Your answer
Mailing Address
Your answer
Phone Number
*
Your answer
Facility to be used?
*
Center Youth Club $100 per event (Additional $100 deposit required)
Auxiliary Gymnasium $50 per event (School Function Only. Additional $100 deposit required, $200 for time clock)
Auditorium $50 per event (School Functions Only. Additional $100 Deposit Required)
Main Gym (School Functions Only)
Commons Cafeteria/Concessions (School Functions Only)
Classroom (After-School Events Only)
Other:
Required
What is the classroom number? (only fill if "Classroom" is selected above)
Your answer
Requested Services
Projector & Screen
Microphone
Kitchen Equipment
Other:
Start Date
*
MM
/
DD
/
YYYY
Start time
*
Time
:
AM
PM
End Date
*
MM
/
DD
/
YYYY
End time
*
Time
:
AM
PM
Recurring Event- Will this event take place every week for a period of time?
Every Monday
Every Tuesday
Every Wednesday
Every Thursday
Every Friday
Every Saturday
Every Sunday
What is the purpose for requesting the facility/name of organization?
*
Your answer
ANTICIPATED FACILITY/RENTAL MUST BE PAID IN ADVANCE; OTHER APPLICABLE FEES WILL BE BILLED AFTER EVENT. Checking the box indicates agreement to all terms.
*
Yes, I agree to all terms of the agreement.
Required
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