Bloomingdale Public Schools Facility Use Agreement
629 E Kalamazoo Bloomingdale, MI 49026 269-521-3906 Fax 521-3971
NOTE: Please fill in all the areas highlighted in yellow and make sure you read the area highlighted in red. A different form should
be filled out for each facility and/or month you are requesting to use it. Once the form is filled out completely, please email to
email@example.com, fax to: 521-3971, or drop off at the Transportation Office at the High School. Thank you.
Date of Request:
School Requested: Room or area:
Time Requested: a.m./p.m. to a.m./p.m.
Dates you wish to use the above: Put an X in each day (Use a different form for each month)
1 2 3 4 5 6 7
8 9 10 11 12 13 14
15 16 17 18 19 20 21
22 23 24 25 26 27 28
29 30 31
Event the building will be used for:
Facility equipment requested:
Information of individual/organization responsible for this facility use request:
Individual name: Phone:
I/We hereby agree that I/We will abide by the rules governing the use of Bloomingdale Plant facilities.
I/We hereby agree that this activity will not discriminate as to sex, creed, race, or age.
I/We hereby agree that any damage to the facilities and/or equipment will be replaced at our expense.
Responsible party Signature & Date Director of Operations Signature & Date
We reserve the right to cancel your request prior to a 4 day notice. Before you leave please police the area.
Transportation Office Use Only: Notified Date
Auditorium manager (If applicable)