Hoxie Grade School Facility Usage Request
Non-school sponsored groups who would like to use district facilities are required to submit a certificate of liability insurance to the district office. If a certificate of liability insurance is not provided, the group representative acknowledges and agrees to hold USD 412 harmless and indemnify USD 412 for any injury or accident incurred by any person during the group's use of the facility. The group representative also agrees to notify all parents, students, spectators, and anyone else who comes on or around the premises during their activity, that they do so at their own risk and USD 412 is not liable or responsible for any injury or accident occurring as a result of the groups use of the facility.
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Email *
Name of Person or Organization *
Name of Adult Responsible for Supervision of Event/Meeting *
Purpose of Event/Meeting *
Phone Number *
Please list a valid phone number that may be used to contact you about the status of your request.
Facilities Requested *
Required
Date(s) Requested *
Please enter in MM/DD/YY Format
Day(s) of the Week *
Required
Start Time *
Time
:
End Time *
Time
:
Special Requests/Comments
A copy of your responses will be emailed to the address you provided.
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