Form 172 - Facility Rental Application
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1
2Office of Business and Finance
1 Franklin Street · Hampton, Virginia 23669-3570 · (757) 727-2335
Facility Rental Application
1) Complete all of Part I, read, sign, and date the Facility Procedures and Regulations in Part II.
2) Complete and return one application for each school requested to the Office of Business and
Finance at least 14 calendar days prior to the event. The Office of Business and Finance will
notify the organization as to the status of the application and to make arrangements for payment of
fees and receipt of insurance documents.
3) Remit appropriate fees at least 10 calendar days prior to the event. Make checks payable to
Hampton City Schools for all rental and utility fees.
Part 1
School/Site Requested:_________________________________________________________________________________________
Contact Person(s):_____________________________________________________________________________________________
Name of Organization: ______________________________________Non-Profit Tax ID#:__________________________________
Billing Address_______________________________________________________________________________________________
City
State
Zip_______________________________________________
Home/Cell Phone:
Email:____________________________________________
Work Phone:
Fax:______________________________________________
Purpose for use of space/describe event in detail:____________________________________________________________________
Space Requested:
Auditorium
Main Gym
Auxiliary Gym
Cafeteria
Cafetorium
Athletic Field
Parking Lot (only)
Other
Utility Requested:
Air Conditioning
Heat
Day(s) Week
Beginning Date
Ending Date
Set Up
Take Down
Total Hours
(M-Su)
Start Time
End Time
1) Are you a neighborhood serving organization registered and in good standing with the Hampton Neighborhood Commission?
(If yes, proceed to question 3)
No
Yes
2) Have you retained liability insurance?
No, coverage must be obtained prior to event.
Yes, please provide the
certificate.
3) Will participants be charged a fee?
No
Yes, amount $______
4) Will spectators be charged a fee?
No
Yes, amount $______
SBO Form 172 Front (Rev. July 2014)
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Parent category: Business