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
