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Use of Facility Form
In accordance to BOE Policy 1330/Administrative Regulation #2
Board approval must occur before any event may take place. Please fill out this form in its entirety at least 1 week prior to the board meeting preceeding your requested date.
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Email
*
Your email
Adult in Charge
(Must remain on premises during entire event)
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Your answer
Address
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Your answer
Phone Number
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Your answer
Insurance Carrier
If not previously provided, please email a current
Certificate of Liability
insurance name
Oxford Central School
as additional insured (minimum $1,000,000 and $2,000,000 aggregate) to
edoyle@oxfordcentral.org
.
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Your answer
Please select 1:
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School Related
Community Related
Governmental
Private
Please select 1:
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Non-profit
Profit
Purpose of Activity
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Your answer
Estimated numer of enrollees/participants at one time:
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Your answer
Number of Adult Chaperones (1 adult per 15 enrollees/partipants)
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Your answer
Janet's Law requires that the team coach or other designated adult present during the athletic event or team practice be trained in CPR and the use of an AED.
Please list the adult(s) with training:
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Your answer
Please list the date(s) of the event, start time(s), and end time(s)
Please note, listed times are the earliest times you are admitted into the building and the time you are expected to vacate it. If you require set-up or clean-up time, please indicate so.
At no time will unsupervised children be allowed to enter the building.
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Your answer
Areas Requested
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Classroom(s)
Library
Cafeteria
Kitchen (fee required)
Gymnasium
Stage
Athletic field and/or playground
Art room
Other:
Required
Special Instructions
Please list any equipment, supplies, or set-up instructions requested. If requesting tables and chairs, please indicate how many and where they should be set up.
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Your answer
Please read below before submission. Check both acknowledgements below to confirm:
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Certain events will require custodial presence. Organizations are responsible for payment at a rate of $25 per hour for each custodian on duty
I have received a copy of the Oxford Township Board of Education's use of school facilities policy and regulations (#1330 and #1330R) and agree to them as stated
Required
A copy of your responses will be emailed to the address you provided.
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