SCSD Facilities Application
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Suffern Central School District
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Application for Facility Use
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Name of Organization:
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Mailing Address:
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Website:
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Phone #:
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Name of person completing application:
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Home address:
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Phone #
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Email address:
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Tax ID #:
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*
School requested:
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*
Room/Field Requested:
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Date(s) Requested:
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Time(s) Requested:
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Equipment needed:
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Do you charge children a fee:
Yes or No
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If no, skips #s 2,3 ,4 & 5 of required documents
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Amount of fee per child:
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What does the fee cover:
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Estimated # of attendees:
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# of children residing in Suffern Central
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# of children residing outside Suffern Central
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Describe nature of activity:
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Required Documents
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This registration form will only be accepted if the following items are attached:
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*
1. Federal Tax ID- also NYS Form (IRS Notification Form & NYS 501C3)
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2, By-laws
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3. Current Bank Statement
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4. List of all prior year cash receipts and disbursements by vendor; W-2s & 1099s
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5. Annual Budget (expected revenue & expected disbursements)
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6. List of all students with names and addresses
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7. Attach Registration form
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Rules
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1. Permit must be available at all times or permit holder may be removed from the site
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2. Roster must be available at all times or permit holder may be removed from the site
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3. There will be absolutely NO subletting of facilities
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4. Tournaments require a separate application
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5. Permits are not transferrable and are only to be used by the entity to whom
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it has been issued. Any unauthorized use will result in the immediate revocation of the permit
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and may result in the entity no longer being eligible to apply for any future permits.
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6. If the School District determines that it would be in the its best interest to do so, permits
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can be revoked at any time prior to the date of the event for which it was issued.
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*Please fill out the following form by putting your organization on the lines provided and sign it.
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Facilitiy usage will not be approved with out it.
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the Suffern Central School District from and against any and all liability, loss, damages,
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claims or actions (including costs and attorney's fees) for bodily injury and/or property damage,
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to the extent permissible by law, arising out of or in any way connected with the actual or
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proposed use of Suffern Central School District property, facilities and/or services, including
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but not limited to bodily injury to any employee, invitee, guest, contractor or subcontractor
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of (____________________________).
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District's property and facilities includes, but is not limited to, all areas indentified in the
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application and/or permit, and sidewalks, walkways, parking lots, entrances, stairs, and all other areas
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incidental to and/or connected with the use of the premises (hereinafter referred to as "incidental areas").
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(________________________) agrees that its indemity and insurance obligtions extend to the areas indentified
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in the application and/or permit and any and all incidental areas.
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This application is only good from July 1st-June 30th of the current fiscal year. A new application must be filled out annually.
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Internal Use Only
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Insurance as required
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IRS FormsApproved (Yes or No)
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By-laws
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Bank Statement
Level of Organization
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List of cash receipts & cash disbursements
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