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 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 ______________

Auditorium                                                                                              Gymnasium

 

Seating requirements on stage________________________                  Seating__________  Scoreboard_________

Tables required on stage_____________________________                  Public address system_________________

Stage curtain and attendant __________________________                   Matron _____________________________

Spotlights _______________________________________                   

Microphones _____________________________________                   Classroom

Podium stand ____________________________________                    ICN ­­­­­­­________________________________

Table ______________   Stand in audience ____________                     Computer lab ________________________

Other equipment __________________________________                   Other  ______________________________

                                                                                                                   Swimming Pool

 

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:

Reviewed: 6/26/2023