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APPLICATION FOR USE OF SCHOOL FACILITIES (COMMUNITY)
COMMUNITY FORM
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* Indicates required question
NAME OF ORGANIZATION:
*
Your answer
CONTACT NAME:
*
Your answer
CONTACT PHONE #:
*
Your answer
CONTACT EMAIL ADDRESS:
*
Your answer
MAILING ADDRESS:
Your answer
PURPOSE FOR WHICH FACILITY IS TO BE USED:
*
Your answer
DATE OF USE:
*
MM
/
DD
/
YYYY
PROPOSED RAIN DATE:
MM
/
DD
/
YYYY
IF EVENT RECURRING, PLEASE LIST ALL DATES BELOW:
Your answer
BUILDING LOCATION:
*
PRIMARY SCHOOL
ELEMENTARY/MIDDLE SCHOOL
Required
(SETUP) REQUESTED FACILITY START TIME:
*
Time
:
AM
PM
(BREAKDOWN) REQUESTED FACILITY END TIME:
*
Time
:
AM
PM
ACTUAL EVENT START TIME:
*
Time
:
AM
PM
ACTUAL EVENT END TIME:
*
Time
:
AM
PM
DOES THIS EVENT REQUIRE THE USE OF A CUSTODIAN:
*
Yes
No
AREA TO BE UTILIZED:
*
ALL PURPOSE ROOM/CAFETERIA (Capacity – 300)
KITCHEN FACILITIES
GYM
LIBRARY
Other:
Required
NUMBER OF PERSONS EXPECTED TO BE IN ATTENDANCE:
*
Your answer
WILL ACTIVITY BE OPENED TO THE PUBLIC:
*
Yes
No
ADMISSION FEE:
*
Yes
No
USE OF SCHOOL EQUIPMENT:
TABLES
CHAIRS
STAGE
Other:
IF YES, HOW MANY TABLES AND/OR CHAIRS:
Your answer
ELECTRICAL EQUIPMENT TO BE USED: (Please Note)
All electrical equipment, if property of the school, must be operated by a school employee (i.e., lighting, sound system, projectors, air conditioning, etc.)
Your answer
INSURANCE INFORMATION:
Do you (the requesting organization) have an in-force public liability policy?
*
Yes
No
If yes, what are the limits of liability?
Your Certificate of Insurance with proper limits of liability, must be submitted at least three (3) days prior to your event.
Bodily Injury $
Your answer
Property Damage $
Your answer
A DEPOSIT OF $100.00 IS REQUIRED WITH THIS APPLICATION FROM ANY ORGANIZATION OUTSIDE DENNIS TOWNSHIP. THE DEPOSIT WILL BE RETURNED AFTER INSPECTION OF THE AREA OF USE PROVIDING IT IS LEFT DAMAGE FREE AND IN A CLEAN AND ORDERLY CONDITION.
Signature of Applicant/Sponsor: (Please enter your full name below)
*
Your answer
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