Request for Use of School Facilities or Equipment
Dolgeville Central School
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Purpose of Request: *
Group Making Request: *
Person Making Request *
Requester's E-mail *
Address: *
Home Telephone:
Cell Phone:
Work Telephone:
Work Fax:
Facility and/or Equipment Requested: *
*PLEASE NOTE - If selecting the Kitchen, the use of the listed appliances requires that your group/organization have a member of the DCS food service staff on duty. Your group/organization may be responsible for reimbursing the District for the hours that employee is on duty.*
Required
Date Requested for Use of Facility and/or Equipment: *
** If requesting multiple dates, select ONLY the first date of requested use and then describe remaining dates in the text box below.
MM
/
DD
/
YYYY
Start Time: *
Please include AM/PM.
Time
:
End Time: *
Please include AM/PM.
Time
:
Additional Date(s):
Describe Any Special Set-Up Requested: *
School Contact Person: *
Phone:
Application Agreement
All non-school related groups must indemnify and hold harmless the District and its agents and employees for and from any loss including attorney’s fees, damages, expense, and liability arising out of their use of school property.  They must pay any damages to school facilities, furniture, or equipment arising out of their use of school property whether such damage was accidental or deliberate.  The cost of damages will be based on the repair or replacement cost, which is at the school board’s discretion. Non-school groups may also be required to reimburse the District for personnel costs related to custodial and/or food service staff who need to be on duty during the event.  If you have a Certificate of Insurance, please also provide the certificate to the district.
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