TREVOR-WILMOT CONSOLIDATED GRADE SCHOOL DISTRICT

USE OF FACILITY REQUEST

Applicant ______________________________________________ Phone___________

Address ________________________________________________________________

Organization_____________________________________________________________

Date(s) of Use____________________________________________________________

Time of Use_____________________________________________________________

Specific Area(s) Requested _________________________________________________

_______________________________________________________________________

Please check one of the following:

School-related or not-for-profit youth organization
Not-for-profit adult organization or other school
Commercial or private organization

It is understood that the above organization:

  1. Will not violate laws which regulate the use of public facilities
  2. Will follow the attached Guidelines and Rules for Building Use
  3. Will assume full responsibility for property damage resulting from use
  4. Will pay fees and wages where required as part of the use of facility agreement
  5. Will provide a certificate of liability insurance naming the Trevor-Wilmot Consolidated Grade School District as an additional insured

The Board of Education reserves the right to reject use of school facilities if it is in the best interest of the school district.

Dated this ___________ day of ____________________, 20_____

______________________________________________________
Organizational Representative

______________________________________________________
Building Administrator