This form is for use by outside organizations wanting to use the following USD #365 Facilities: ACJSHS or Ray Meyer Gymnasium.
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Organization/Group: *
Your Name: *
Your Address: *
Your Email:
Your Phone Number: *
Building You Would Like To Use: *
Specific ACJSHS Areas You Would Like To Use: (Check All That Apply) *
Date(s) of Use: *
Time(s) of Use: *
Needed Equipment or Furniture:
Other Information We Need to Know:
Please Read and Acknowledge Below:
In signing this request I certify that I am duly authorized to represent the organization/group named above in reserving the specified facilities. I agree that Unified School district No. 365, Anderson County, Kansas, will be held harmless from all losses, damages, injuries, claims, debts, legal actions and associated fees resulting from the the defense or prosecution of the district's rights which may be occasioned by the use of said facilities. I further agree to the usage fee outlined below, payable prior to the first date of use, and additionally to pay promptly for any damages to the property or equipment of the district which may reasonably be assessed to me or the organization/group I represent resulting from use of said facilities. I further agree that the district through its administration reserves the right to deny or revoke the use of said facilities to me or the organization/group I represent for any abuse of the privilege granted through this agreement. Finally, I understand that school events and activities have priority and may be rescheduled at any time without notice.
Please type your full name in the box below, which indicated your agreement with the above statement: *
Date: *
Whole Building - $150/hour or $1000/day
Gymnasium, Cafeteria, Commons, Auditorium - $50/hour or $500/day per area
Classrooms - $10/hour or $100/day per room
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