1005.1E1 Community Use of District Facilities and/or Equipment Request Form

Facility/Equipment Requested:_____________________________________________________

Date of Event:__________________________________ Alternate Date:___________________

Set Up Time:_________________ Start Time: __________________ End Time: ____________

Group Title: _________________________ Purpose of Activity:________________________

Admission charged? ____Yes ____No ________ Amount______________ For Profit? _____

Contact Person: _________________________________ No. people expected ____________

Address: ________________________________ __________________________________

Phone: (Business) __________________________ (Home) _____________________________

Email Address: _________________________________________________________________

CUSTODIAL SERVICES NEEDED: To Open ____ To Close ____ During use____


 _____ Bleachers                                _____ Lunch Tables               _____Volleyball nets

_____ Chairs                                       _____Writing Tables              _____ Basketball hoops

 _____ Dressing Rooms                     _____Shower Rooms _____ Media Equip:

 _____Microphones                            _____Podium                          _____Stage Lights


Other:  ________________






The user hereby agrees to follow all applicable Board policies and the law in its use of District facilities and/or equipment. The user specifically agrees to follow the following rules:

1.         NO SMOKING in school buildings or on school grounds.

2.         Only the group requesting the use of facilities is to be in the school buildings.

3.         The hold-harmless agreement below must be signed by a person representing the group.  



The undersigned, hereafter referred to as “entity,” states that it will hold the Spirit Lake Community School District, hereafter referred to as “District,” its employees, officers, agents, and/or representatives harmless from any and all damages and claims that may arise in connection with the entity’s use of any facilities and/or equipment owned by the District whether such damages and claims pertain to the entity itself or its guests. In case any action is brought against the District or any of its officers, employees or agents, and/or representatives the entity will assume full responsibility for the legal defense thereof, and upon its failure to do so upon proper notice, the District reserves the right to defend such action and to recover all costs, including attorneys’ fees, from the entity.


Signature:______________________________________ Date: ________________________



____Approved                        $__________ Use fee                        __________________Supt/Principal

 ____Disapproved                   $__________ Custodial fee   ____________________Date ____$100 Key Deposit    $__________ Total                ____________________Recorded


Please send fee to Business Manager, Spirit Lake Community Schools, 2701 Hill Avenue, Spirit Lake, Iowa 51360 within thirty (30) days.




Reviewed: 4/8/19

Revised: 7/8/13