Facility Rental Form - rev 9/23

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1			Indiana Area School District, Indiana, PA						Copies to:
2			APPLICATION FOR USE OF SCHOOL FACILITIES						Copies to:
3	Name of Organization:									Applicant
4	Name of Organization:									Bldg. Principal
5	Type of Organization: (Civic, Service, Social, Recreational, etc.)									Supv Bldg/Grd
6										Head Custodian
7	Is your organization CO-SPONSORED by the Indiana Area Rec Department?									Athletic Director
8	Yes		No		If yes, signature of approval of the Rec Department Director:					Auditorium Coordinator
9	Signature:						Date:			Accts. Rec.
10	Signature:						Date:			Central Office
11	Rec. Department Director Signature (If Necessary):						Date (If Necessary):			Other
12	Rec. Department Director Signature (If Necessary):						Date (If Necessary):			File
13	Requests approval for the use of the following facilities of the Indiana Area School District:
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15	School Building Requested:
16	School Building Requested:
17	Room(s) or Area(s) Requested:				New Gym		Concession Stand			Locker Rooms
18	Room(s) or Area(s) Requested:				Old Gym		Classroom #	(xxx)		Team Room
19	Click all that apply:		Rifle Range/Batting Cage Room			Auditorium		Wrestling Room		Ticket Booth
20	Click all that apply:		Other (Please Specify Below)			LGI		Health Room		Restrooms
21						Main Parking Lot		Practice Field		Football Field
22						Student Parking Lot		Band Practice Area		Soccer Field
23								Lower Commons		Upper Commons
24	Date/s:			Set up time:			Event end time:
25	Date/s:			Event start time:			Final end time:
26	Purpose (Please explain in detail: Attach additional sheet if necessary):
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30	If admission is to be charged, state as specifically as possible what proceeds are to be used for:
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33	Equipment requested: (Please explain: Attach additional sheet if necessary.):
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36	Approximate number that will be in attendance:
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38	I have received and read the Indiana Area School District Rules and Regulations regarding use of school property and do hereby accept responsibility for meeting the requirements therein. (See reverse side.)
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40	First and Last Name:
41	First and Last Name:
42	Address:						Cell Phone No.:		Date:
43	Address:						Cell Phone No.:		Date:
44	Email Address:						Home/Work Phone No.:		Ext.:
45	Email Address:						Home/Work Phone No.:		Ext.:
46	NOTE: Incomplete Applications Will Not Be Processed
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49	FOR SCHOOL USE ONLY:
50	Approval:		School Principal:					Date:
51	Disapproval:		School Principal:					Date:
52	Approval:		Business Manager:					Date:
53	Disapproval:		Business Manager:					Date:
54	School Police Required:		Number:					No:
55	School Police Required:		Number:					No:
56	Charges:
57	Charges:
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61	Rules and Regulations
62	Regarding Use of School Property
63		1. Procedures
64		1. Initiate application at the school where use is requested to clear school calendar. If your group is co-sponsored by the Indiana Area Recreation and Parks Department, the signature of its director or designee is required on the front page.
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66		2. Submit application with copy of Certificate of Insurance to Principal for approval of availability of area desired.
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68		3. Principal will process application and forward to the District Superintendent’s Office.
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70		4. Business Manager will indicate rental charge, if any.
71		4. Business Manager will indicate rental charge, if any.
72		5. Approved copies will be sent to the Applicant, Principal, Head Custodian, Business Office, School Police Chief (if police are required), and Recreation Department (if required).
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75		2. Rental Charges*
76		Non-Community Non-Charitable				Community/Charitable Groups
77						Requiring Additional District Personnel Service		Requiring Regular District Personnel Service		Groups Co-Sponsored by Rec. Dept.
78						Requiring Additional District Personnel Service		Requiring Regular District Personnel Service		Groups Co-Sponsored by Rec. Dept.
79				Per Hour	Min. Charge	Per Hour	Min. Charge	Per Hour	Min. Charge	The actual additional costs incurred by the district to be determined after the use of the facility.
80		Auditorium		$75.00	$150.00	$50.00	$100.00	$25.00	$50.00
81		Gymnasium		50	100	20	40	10	20
82		Multi-Purpose		35	70	15	40	5	10
83		Cafeteria		35	70	15	40	5	10
84		Classroom		25	50	10	40	N/C	N/C
85		Playground		25	50	10	40	N/C	N/C
86		*The rental charges shown above are a general guideline. The Business Manager may adjust these charges upon learning of all the specifics of the facility use, i.e., if additional district personnel are needed. It is the intent of the district to keep these charges at a minimum; however, it is not its intent to absorb any excessive costs. PTA’s are exempt from all rental charges and contractual agreements.
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90		3. Rules and Regulations
91		1. THE RENTER MUST SHOW EVIDENCE OF A VALID INSURANCE POLICY TO COVER ITSELF IN CASE OF LIABILITY/PROPERTY DAMAGE AND/OR BODILY INJURY IN THE MINIMUM AMOUNTS OF $100,000 COMBINED SINGLE LIMIT OR $100,000/$300,000 LIABILITY/BODILY INJURY AND $50,000 PROPERTY DAMAGE. A CERTIFICATE OF SUCH COVERAGE MUST BE ATTACHED TO THE APPLICATION OR BE ON FILE IN THE DISTRICT OFFICE.
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95		2. Tobacco, alcoholic beverages and gambling are prohibited.
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97		3. Organizations using school property are responsible for the conduct of participants and spectators and must make adequate provisions to handle anticipated crowds.
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99		4. Permission for use, when granted, is for specific rooms or areas, and the remainder of the building is not to be entered.
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