905.1E1 - Application For Use of School District Facilities

APPLICATION FOR USE OF FAIRFIELD COMMUNITY SCHOOL DISTRICT FACILITIES

* Complete and return to building principal and/or activities director.

Day(s)/Date(s) Wanted (please be specific):               ______________________________________________________________

This is a(n): __________ one time request                      __________ ongoing request from __________ to __________

Building wanted:        _____ HS             _____ MS            _____ Pence              _____ Washington         _____ Libertyville

                                           _____ Lincoln   _____ ACT

Area wanted:                _____ Gym         _____ Field        _____ Commons     _____ Classroom           _____ Auditorium

_____ Kitchen   _____ Other : specify:_______________________________

Time wanted: ____________________       Hours building is to be open: _________________________

My signature indicates that I have received a copy of the district’s policy (Code No. 905.1) regarding the use of a FCSD facility and/ or equipment and agree to abide by it.  I also agree:

1. To provide adult supervision for all participants and spectators.
2. That street shoes will not be worn on gym floors, pianos will not be moved, and electrical outlets will not be altered.
3. That alcoholic beverages and tobacco products will not be present on school property.
4. To be responsible for carrying the proper insurance for the group’s activities.
5. That the school district and agents will not be held responsible for the accidents, injuries, or theft of personal property incurred by those parties authorized to use the district facilities.
6. To leave the facilities in good condition, comparable to the way they were prior to use, and to pay labor charges if I fail to do so.
7. To be responsible for any damage to equipment or property which occurs during or as a result of the rental, and to report any damage to the building principal or activities director.
8. To adhere to the terms of this agreement and any additional terms imposed by the building principal or activities director.
9. That failure to abide by the above mentioned terms or repeated abuse of the facilities will result in cancellation of this and any future contracts.
10. To notify the building principal or activities director of a cancellation or variation.
11. Sponsoring organizations must stay on site until all underage individuals are off the property.

 

Signature: ___________________________________ Name (please print): ___________________________________

Organization: ___________________________________         Nature of Activity: ___________________________________

Home Phone: ___________________________________         Cell Phone: ___________________________________

Address: ___________________________________    City, State, Zip: ___________________________________

Number of People in Group: ______________   Adults: ______________              Youth: ______________

Certificate of Insurance Coverage Attached: ______________

 

*************************************** FOR OFFICE USE ******************************************************

Rental Schedule (Circle One):   A   B   C   D   E   F     Facility use charges: __________       Other charges __________

Custodian Charges: __________   Hours: __________   Other personnel charges: __________   Hours: __________

Special Notes: _______________________________________________________________________________  Amount Deposit: __________

Signature Principal or A.D.: ______________________________   Date: ____________________