The undersigned entity makes application for the use of the school district facility or equipment as designated below. The entity will provide police protection at its own expense, if necessary, to maintain order and to properly protect the building, site, or equipment. Police protection is required when admission is charged.
Please refer to Policy 905.1 to determine the proper use of school facilities and equipment. The entity is responsible for complying with the law, board policy and the administrative regulations.
The entity must provide an Indemnity and Liability Insurance Agreement, Code No. 905.1E2, prior to the use of school district buildings, sites, or equipment
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Building/Site/Equipment |
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Purpose |
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Hours |
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Auditorium |
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Gymnasium |
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Seating requirements on stage |
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Seating |
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Scoreboard |
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Tables required on stage |
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Public address system |
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Stage curtain and attendant |
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Matron |
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Spotlights |
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Microphones |
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Classroom |
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Podium Stand |
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ICN |
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Table |
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Stand in audience |
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Computer lab |
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Other equipment |
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Other |
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Swimming Pool
Total Fee $
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Name of entity making application: |
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Name of person making application: |
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Address: |
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Phone #: |
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(Signature of Applicant) |
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(Date) |