Do Not Write Below This Line – Administration Only
All requests for the use of athletic fields, facilities and/or equipment must be reviewed by the Athletic
Director prior to review by the Principal (or Designee)
Athletic Director: ________________________ Approved:
Disapproved:
Athletic Director Signature: ________________ Reason for Disapproval: _________________________
Principal: _______________________________ Approved:
Disapproved:
Principal Signature: ______________________ Reason for Disapproval: _________________________
School Board: ___________________________ Approved:
Disapproved:
Secretary Signature: ______________________ Reason for Disapproval: _________________________
Priority Group Designation: ______________________________________________________________
Prepayment Deposit Required: __________ Amount Due (Paid within ten (10) days of approval: _____
Total Payment: (Paid within ten (10) days after the event/activity concludes) _____________________
District Personnel Required: _____________________________________________________________
Custodian on Duty: __________________________________ Hours: ____________________________
Comments: ___________________________________________________________________________
Security on Duty: ____________________________________ Hours: ____________________________
Comments: ___________________________________________________________________________
_____________________________________________________________________________________
Cafeteria Staff: _____________________________________ Hours: ____________________________
Comments: ___________________________________________________________________________
_____________________________________________________________________________________
Concession Sales: District-Sponsored Organization: __________________________________________
Advisor/Coordinator: ___________________________________________________________________
Principal: _____________________________________________________________________________
Comments: ___________________________________________________________________________
_____________________________________________________________________________________