Facility Use Form
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Organization Name
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Contact Person
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Contact Address
Physical Address
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Telephone Number
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Building
Purpose
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INDEMNIFICATION, INSURANCE REQUIREMENTS, AND CONDITIONS FOR USE OF SCHOOL FACILITIES
Applicant had an opportunity to inspect and accepts the premises and facilities in their present condition, and stipulates that the premises and facilities are in clean, safe and usable condition. Applicant accepts the premises “as is” and assumes all risks of any condition of the property, whether visible or not. Applicant agrees that the Narragansett Regional School District makes no representations or warranties as to the condition of the facilities. Applicant agrees to protect, defend, indemnify, save and hold harmless the Narragansett Regional School District, its Board of Trustees, the individual members thereof, and all officers, agents, employees and representative free and harmless from any and all liability, loss, damage, cost or expense in any way connected with Applicant’s use or occupancy of the premises and facilities. Applicant shall, at its own cost and expense, procure and maintain during the entire period of use of the premises and facilities commercial general liability insurance issued by a qualified insurer licensed to do business in the Commonwealth of Massachusetts or a self-insured program acceptable to Narragansett Regional School District, with a combined single limit of not less than $1,000,000 per occurrence. Such insurance shall name the Narragansett Regional School District, its School Committee, the individual members thereof, and all other agents, employees, and representatives’ additional insured. Applicant shall, at its own cost and expense, procure and maintain during the entire period of use of the premises and facilities commercial liability insurance issued by a qualified insurer licensed to do business in the Commonwealth of Massachusetts or a self-insured program acceptable to Narragansett Regional School District with bodily injury limits of not less than $100,000 per individual/$300,000 per occurrence and property limits of not less than $100,000. Applicant shall provide certificates of insurance as well as letters of endorsement from its insurers. It is understood that Applicant’s liability is not limited to the Applicant’s policy limits. Applicant understands that this provision is a material term of the permit for use of premises and facilities.

It shall be the applicant’s responsibility and obligation to assure that the property and facilities are in proper and safe condition to be used for the purpose anticipated. The applicant acknowledges that it shall be obligated to inspect such property and facilities before they are used and to take affirmative steps where necessary to warn users or rectify hazards in order to prevent injuries to property and persons. Applicant shall also be obligated to isolate and inspect property and facilities during use and to ensure that they are left in a safe and secure condition when unattended. Written inspection reports shall be forwarded to the Business Manager on a weekly basis. Any property, fixed or portable, remaining on District property during or after use shall be secured in a manner that will effectively prevent accidents and other occurrences that may jeopardize the safety and welfare of persons on District property. Any property, fixed or portable, shall be labeled with a sign identifying it as Applicant’s property. Signs shall be conspicuous in size so that a reasonable person would be able to discern their contents. All property, fixed or portable, shall comply with all codes and regulations pertinent to such property. The District reserves the right to inspect facilities to ensure that conditions are safe. Any property, fixed or permanent, that the District feels may contribute to an unsafe environment must removed at the request of Business Manager. The District assumes no responsibility whatsoever for any property placed on premises.

In the event Applicant fails to perform in accordance with the preceding paragraphs, or otherwise breaches any other provisions of the permit for use of the premises and facilities, Narragansett Regional School District shall be entitled to recover all legal fees, costs, and other expenses incident to securing performance or incurred as a consequence or nonperformance.

Participation
Number of people participating
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Activity Date
MM
/
DD
/
YYYY
Recurring
Start Time
Time
:
End Time
Time
:
Access needed before or after
(set-up, rehearsals, etc.)
Required
Early Access
Please provide detail on when you need early access.
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Facilities Requested
Check all that apply
Required
Entry
Door(s) that would need to be unlocked
Required
Entry Details
Input time when door(s) should be unlocked. Example: "30 mins before event is starting for an hour", "whole event", "6:00pm - 7:00pm", etc.
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Police
If requested, the school will hire and pay police, and you will be charged accordingly.
Police Details
If police are requested, provide who is responsible for coordination.
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Cleanup
Who will be responsible for cleanup?
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Kitchen
Who will be opening Kitchen, if need be?
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Info
Additional Information/Comments/Use of Specialized Equipment Request:
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Disclaimer
One time use of a district facility will require payment at the time the application is submitted for use of the facility. Parties who sign up for multiple uses of the facility will be billed on a monthly basis. Final payment will be required prior to the last day of use.
Please make checks payable to: Narragansett Regional School District
100% NO TOLERANCE ZONE FOR ALCOHOL, TOBACCO OR DRUGS
Hazing and use of any of the above products within the school buildings, the school facilities, on the school grounds or on school buses by any individual, including school personnel, is strictly prohibited.
Signature
In compliance with the e-sign act of 2001 please type your name here to sign this document.
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