School Facilities Rental And Use Agreement Form printable pdf download

Chehalis School District #302

School Facilities Rental and Use Agreement

NAME OF ORGANIZATION

DATE

NAME OF REPRESENTATIVE

TITLE

BILLING ADDRESS

PHONE

(H) -

(W) -

Street ___________________________________________________________________

FAX

City __________________________________ State ___________ Zip _____________

SCHOOL BUILDING/FACILITY

DATES

TIME

(LIST INDIVIDUALLY)

Activity to begin

_________a.m./p.m.

OPEN TO PUBLIC? YES___ NO___

SPACE REQUESTED

ADMISSION FEE? YES___ NO___

NUMBER ATTENDING ___________

Activity to end

_________a.m./p.m.

DESCRIPTION OF ACTIVITY -

SPECIAL INSTRUCTIONS

*if videoconference, see below

We agree to abide by and enforce the rules and regulations of the Chehalis School District governing the non-school use of buildings, grounds, and

equipment as printed on the reverse side of this form. We agree that School District and School District’s agent, employees and directors shall not

be liable for any damage to person or property by reason of the negligent acts of applicant, its agents, employees, invitees or subcontractors. We

agree to protect, indemnify for costs, legal and other expenses, and hold harmless School District and its officers, employees, directors and agents

from all claims, liabilities or suits arising out of injury to person or property from negligent acts of applicant, its agents, employees, invitees or

subcontractors, and thereby applicant assumes all such claims, liabilities or suits. Applicant will provide a certificate of insurance naming

Chehalis School District as other insured for the period of this rental.

Please contact the School Office if you have any

questions, changes, or cancellations.

I have read and understand all RULES AND REGULATIONS

SCHOOL/BUILDING APPROVAL

specified on the back of this form; I am authorized to sign this

agreement.

___________________________________________

________________________________________

APPLICANT SIGNATURE

BUILDING ADMINISTRATOR

DATE

For School District Use

Waiver of fees approved by:

Insurance Certificate Received _______________________________

____________________________

Please note: Even if rental fees are waived, custodial charges still apply.

Superintendent

Your organization will be billed separately and overtime may be

applicable.

Date:

_____________________________________

Charges to User:

Rental

$______________________

Custodian on duty: _________________________

Custodial Services: Reg/O.T.________ hours @ $__________ per

$______________________

hour

Total Charges

$______________________

Deposit Paid ___________________ Date __________

Total Due

Remittance to be paid to:

Chehalis School District, 310 SW 16

Street, Chehalis, WA 98532

* VIDEO CONFERENCING ROOM

Facilitator Needed

Yes

Custodian Services Requested?

Yes

Facility Rental Form

1 Copy to District Office

09-12-06

1 Copy to Custodian

1 Copy to Applicant

School Facilities Rental And Use Agreement Form

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