CCA Community Activity Form
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Email *
Please submit this request form at least 2 weeks before your event. This form must be filled out and approved before holding any enrichment activity or special event at CCA. In submitting this request, you understand that you will be responsible for setup and cleanup in the room used, as well as, making arrangements for securing the building when used after school hours.
Primary Event Contact *
Primary Event Contact Email *
Primary Event Contact Phone Number
Purpose/ Name of Event *
Date of Activity *
MM
/
DD
/
YYYY
Total Event Time *
Ex: 11:00am - 1:00pm
Location of Event (Room) *
Ex: Cafeteria
Outside Vender's Name and Contact Information (If Applicable)
Technology Equipment Needs (please check all that apply)
If applicable, please describe how many microphones and microphone stands you need.
Equipment Needs (please check all that apply)
If applicable, please describe how many cafeteria tables, folding tables, and folding chairs you need.
Please list any other requests below.  
By typing my name below, I acknowledge that I have obtained permission to use the intended space(s) by the person(s) in charge of the space. *
Ex: If the library is involved, get librarian's signature.
A copy of your responses will be emailed to the address you provided.
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