Building Use Application- CBMS
Name of individual responsible for event: *
Your answer
Organization *
Your answer
E-mail Address
Your answer
Mailing Address *
Your answer
Telephone Number(s) *
Your answer
On behalf of the individual or organization above, I hereby request permission to use the following area(s) of TBPS/CBMS: *
Date(s) and Time(s) I am requesting this building use: *
Your answer
What is the purpose of this event? *
Your answer
How many attendees do you expect at this event? *
Your answer
I need the following equipment supplied for this event:
Chairs, tables, podiums, sound system, overhead projector, screen, TV/VCR/DVD only
Your answer
I need custodial coverage for our event: *
We are a certified NON-PROFIT Organization: *
Note: Non-profit status needs to be proven through a valid 501(c)(3) certificate. If the organization or person is a FOR-PROFIT Organization, a copy of personal or corporate liability insurance must be provided prior to your scheduled event. For more information, call your insurance agent directly.
I have arranged for a sheriff or security officer to be present on-site at all times. *
At the discretion of the school Administration, security may be required.
I (We) hereby agree to comply with the policies, regulations and rules of the Waterbury-Duxbury School Board, governing the use of school facilities. I (We) agree to take the utmost care in the use of school property, and pay for any damages, loss of school property, or cleaning, arising from our use of the building. *
By checking yes below, you cite that you agree with the above statement.
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