CCA Community Activity Form
* Required
Email address
*
Your 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
*
Your answer
Primary Event Contact Email
*
Your answer
Primary Event Contact Phone Number
Your answer
Purpose/ Name of Event
*
Your answer
Date of Activity
*
MM
/
DD
/
YYYY
Total Event Time
*
Ex: 11:00am - 1:00pm
Your answer
Location of Event (Room)
*
Ex: Cafeteria
Your answer
Outside Vender's Name and Contact Information (If Applicable)
Your answer
Technology Equipment Needs (please check all that apply)
Mac Computer
PC Computer
Sound for Computer Presentation
Projector and Screen
PA System
Microphone
Microphone Stand
Podium
Megaphone
If applicable, please describe how many microphones and microphone stands you need.
Your answer
Equipment Needs (please check all that apply)
Bleachers
Cafeteria Tables
Folding Tables
Folding Chairs
Stage and Steps
Set of Stanchions
Backdrop to Stage
If applicable, please describe how many cafeteria tables, folding tables, and folding chairs you need.
Your answer
Please list any other requests below.
Your answer
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.
Your answer
A copy of your responses will be emailed to the address you provided.
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