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____
EQUIPMENT NEEDED:
_____ Bleachers _____ Lunch Tables _____Volleyball nets
_____ Chairs _____Writing Tables _____ Basketball hoops
_____ Dressing Rooms _____Shower Rooms _____ Media Equip:
_____Microphones _____Podium _____Stage Lights
Other: ________________
________________
________________
________________
RULES:
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.
HOLD-HARMLESS AGREEMENT:
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: ________________________
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DISTRICT OFFICE USE ONLY:
____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.
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Approved: |
Reviewed: 4/8/19 |
Revised: 7/8/13 |