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Utilization of School Facilities Form

Printable Form

SECTION I

Section I to be completed by person requesting utilization of school facilities.

A. Personal Information

Name of Organization:

Officer of Individual Responsible:

Address:

Home Phone Number:

(ex: XXX-XXX-XXXX)

Work Phone Number:

(ex: XXX-XXX-XXXX)

B. Information about Organization

Please Select the best class that describes your organization

See School Board Policy for more information

Class I - School District Related
Class II - Non-Profit WASD Resident Organization

Class III - Profit or Non-WASD Resident Organization

C. Request(s)

Which Facility does your organization wish to use?

Seneca High School Middle School Elementary Center Athletic Fields

Faculity to be used for:

Date(s) Desired (ex: xx-xx-20xx)		Has this date been verified by the school office?	Yes No
Number of participants
Will funds be raised at this event?	Yes No	Will games of chance be conducted?	Yes No
Facility to be opened at:		AM PM
Length of activity (Provide in hours)

Special Request:

Special Request would include number of tables needed, audiovisual equipment needed, PA equipment needed, etc.

D. Acknowledgement

I have read and understand School District Policy Number 3513 regarding Utilization of School Facilities. I will be responsible for compliance with this policy during the period of use. I acknowledge and agree to pay any fees, if applicable. I understand that a contract may be issued, upon Board of Education approval.

Agree Disagree

Please note: Any forms marked disagree will NOT be considered.

Date: (ex: xx-xx-20xx)

Please Note: You will be contacted upon approval/denial of request.