Code No. 905.1E1
COMMUNITY USE OF FACILITIES & EQUIPMENT -APPLICATION FORM
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, Policy 905.1E2, prior to the use of school district buildings, sites, or equipment
Building: _________________________ Date of Use: ___________ Hours: ________________ Room(s):______________________________________________________________________
Purpose: _______________________________________________________
Auditorium Gymnasium
Seating requirements on stage _________ Seating,_____ Scoreboard _________
Tables required on stage ______________ Public address system ____________
Stage curtain and attendant. ___________ Employee______________________
Spotlights_____________________
Microphones_____________________ Classroom
Podium Stand ____________________ ICN___________
Table __________Stand in audience _______ Computer lab ________
Other equipment _________________ Other ___________________________
Total Fee Due: $___________________
Organization: ____________________________________________________
Contact Person: ___________________________Telephone:______________
Address: ________________________________________________________
________________________________________________________________________________
(signature of applicant) (date)
Approved: ____________ Reviewed 2-24-14 Revised 1-21-2019
RIVERSIDE COMMUNITY SCHOOL DISTRICT BOARD OF DIRECTORS