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Pleasant Valley School District

Facility Use Applicant/Responsible Party Statement

khaws@pvsd.k12.ca.us

(805)445-8663

600 Temple Avenue, Camarillo, CA 93010

As an Applicant, it is your responsibility to familiarize and hereby agree to abide by the rules, policies, and regulations of

Pleasant Valley School District (PVSD) and of the State of California. By signing below, you are agreeing to follow all PVSD

rules, polices, and regulations. Failure to comply may result in cancellation of facility usage. Additionally, please take

special note of the following which are critical to campus and student safety:

Tobacco products, alcohol, and drugs are strictly prohibited.

BP/AR 3513.3, 5131.6 (PVSD Board & Regulation Policy)

2. Outside user groups may not bring food into classrooms.

3. To ensure the safety of all students, no peanuts or peanut-containing products may be taken into PVSD facilities

by outside user groups.

4. Food preparation including barbecuing on PVSD facilities is not allowed. Please prepare food off-site.

5. Student safety is one of our highest priorities. Any groups engaging in activities which create a hazardous

environment or situation will be asked to leave immediately.

6. Outside groups must confine activities to the areas being rented. Supervision of activities is required at all times.

Unattended children and/or students on a school campus are not permitted.

7. Vehicles are restricted to parking lots only. Vehicles are not permitted to drive on campuses at any time, even for

deliveries or set-up.

District approval is required five (5) working days prior to posting any flyers, signs, and/or banners.

BP 1325

9. Facilities will be opened/closed at the times stated on the application. Do not anticipate or call for earlier access.

10. User groups agree to keep facilities clean, passageways clear and accessible, and properly dispose of all

food/trash.

Applicant agrees to be solely responsible for any and all liability, claims, loss, damages, costs and expenses, including

attorney's fees, arising out of or resulting from any injury to persons or damage to property which arise out of its use of

the District's facilities. Applicant agrees to defend, indemnify and hold harmless the District, its officers, agents,

employees and volunteers against any and all such claims, demands, causes of action, suits and expenses, arising out of

or resulting from its use of the District's facilities.

I further understand the reservation for use of facilities will not be complete and binding until all information

requested is submitted as follows: 1. $25.00 Application Fee (non-refundable) 2. For each event, a certificate for one

million dollars’ worth of liability insurance to cover any injury, loss, or damages caused by the negligence of user

group and participates for its duration. This certificate must list as additional insured: Pleasant Valley School District;

3. Facility Use Applicant/Responsible Party Statement; 4. Facility Use Reservation Application; 5. Facility Use

Reservation Calendar; 5. Facility Use Set-up Diagram (if applicable). Facility Use Application(s) shall be submitted no

less than 10 working days prior to event. Any revisions and/or cancellations shall be submitted in writing to the

district office no less than 48 hours prior to said day of event. In the event of an emergency, I will contact Tino

Ocampo, (805)207-3391 or Chris Johnston, (805)391-3121.

_____________________________________________

_________________________________

______________

Signature of Applicant/Responsible Party

Organization

Date

Rev. July 17, 2014

Page 1 of 4

Form 1330 E-2 - Application And Agreement For Use Of School Facilities - Pleasant Valley School District - 2014

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