Building Use Request Form
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1
2SCHOOL FACILITIES
05.31 AP.21
Building Use Request
Name of Sponsoring Organization_______________________________________________________
Representative’s Name __________________________________________
Telephone __________________
Billing Address ______________________________________________________________________________
The above organization/individual requests the use of:
gymnasium
kitchen
classroom(s)________________________________________
other, specify _______________________________________________________________________
Building/school/facility _________________________________________________________________________
Date(s) requested _______________________________________Time(s) Requested________________________
Activity:_____________________________________________________________________________________
Is the organization planning to conduct sales on school premises?
YES
NO
YES
NO
Will public be admitted?
YES
NO
Will admission be charged?
YES
NO
Will sales be conducted?
If yes, what will be sold and how will the proceeds be used?__________________________________________
____________________________________________________________________________________________
Copy of the organization’s insurance certificate has been filed with the Board (See #3 below) YES NO
Fee
Employees Required
# of
Hourly Rate
Estimated
Actual Bill
Schedule
Hours
(Overtime 1.5 x rate)
Costs
(C.O. Use)
Building Use
$50
Custodians
Food Service
Other
Total
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Parent category: Business