905.1E1 - Community Use of School Facilities and Equipment Application Form

COMMUNITY USE OF SCHOOL DISTRICT BUILDINGS & SITES & EQUIPMENT

APPLICATION FORM

Code No. 905.1E1

The undersigned entity makes an 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 or site.

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 or sites.

Building/Site/Equipment_____________________________________Date ________________

Purpose ___________________________________________________Hours ______________

For Profit-Select your Choice		Non Profit-Select your Choice
Colesburg Gym	$150 per day or $20 per hour	Colesburg Gym	$10 per hour
Edgewood Gym	$150 per day or $20 per hour	Edgewood Gym	$10 per hour
Varsity Gym	$300 per day or $40 per hour
Gym Equipment (All Gyms)	$50 flat fee	Gym Equipment (All Gyms)	Part of Custodial Fee
		High School Commons	$10 per hour
Classroom	$10 per hour	Classroom	$10 per hour
Baseball Field	$300 per day	Baseball Field	$20 per hour
Track	$150 per day or $20 per hour	Track	$20 per hour

Custodial Fee: $ ____________

Total Fee $_________________

Name of entity making application:_________________________________________________

Name of person making application: _______________________________________________

Address: _______________________________________ Phone #: _____________________

_____________________________________ _____________________________

(Signature of Applicant) (Date)

I.C. Iowa Code: § 123.46; § 276; § 278.1; § 279.8; § 297; § 8D

Cross References: 705.4 Expenditures for a Public Purpose

905.2 Nicotine/Tobacco-Free Environment

Revised: 9/8/2025

Reviewed: 9/8/2025

dawn.gibson.cm… Mon, 07/05/2021 - 18:00

File Attachments

905.1E1-Community Use of School District Building & Sites.docx (4).pdf