FORM: H3P-2
- S A M P L E F O R M -
Application For Use of School Facilities:
______________ School District
Date: ______________________
Please submit this form, in duplicate, to:
(Name, address, fax)
The undersigned hereby makes application on behalf of
_______________________________________ for permission to use the
__________________________________ (facilities desired) on ____________(date)
from _________(am/pm) to _________ (am/pm) for the following purpose:
________________________________________________________________
________________________________________________________________
The charge for use of above referenced facility and purpose will
be $___________. The proceeds will be donated to
_________________________________________.
If said permission is granted, we hereby agree to comply with the
rules, procedures and policies of the Board of School Directors governing the
use of school facilities and to take the utmost care in the use of school
property, and to pay for any damage to or loss of school property arising from
our use of the building.
Furthermore, we agree to pay the fee charged for the rent, if any,
and services of any personnel required and appointed by the school.
Organization: ________________________________________________________________
Representative and Title:
___________________________________________________
Address:
________________________________________________________________
Telephone: _____________________ Day _________________ Evening
FOR DISTRICT
PERSONNEL ONLY:
The above application is approved and charges will be as follows, payable to
the ___________________ School District.
Rental $_______________ Custodian $_______________ Deposit
$_______________
Supervisory: $_______________ Police $_______________ No charge
_______________
Other charges/conditions:
____________________________________________________________
Signed:
____________________________________, Principal Date: __________________
The above application is DENIED for the following reason:
___________________________________
_______________________________________________________________________
Signed: ____________________________________, Principal Date: __________________