HELLGATE ELEMENTARY SCHOOL DISTRICT #4 BUILDING USE APPLICATION
ONLY Room (s) and/or Equipment requested below will be made available for your use. TIMES listed will be strictly observed.
Name of Organization________________________________________________________________________ Purpose of Use_____________________________________________________________________________ Contact Person__________________________________________________Phone______________________ Mailing Address____________________________________________________________________________ Date Starting____________________________________Date Ending_________________________________ Duration of Use_____________________________ Start Time______________End Time_________________ Approximate Number Attending_______________________________________________________________ Facilities to be used__________________________________________________________________________ (Gym #1, #3, Multi-Purpose Room, etc.) Equipment you would like school to provide______________________________________________________ __________________________________________________________________________________________ (tables, chairs, etc *** No athletic equipment will be provided.) Technology Application/Information____________________________________________________________ _________________________________________________________________________________________ Comments:________________________________________________________________________________ _________________________________________________________________________________________ Five days notice required for building use. Failure to show without notification will void this application. Failure to keep off of folded bleachers will result in loss of building use. This application must be completed and presented to the building principal and approved before the facilities can be used. Unless waived by the Hellgate Elementary Board of Trustees, liability insurance is required for any activity involving children. Please present documentation to district office. The undersigned also understands that the school shall not take responsibility for supervision of non-school activities even though school personnel are involved. In addition, a school administrator can withdraw approval of this request at any time. _____________________________________________ __________________________________________________ (Signature and Date) (Administrative Approval Signature and Date) ______________________________________________ (Custodial Approval and Date)
Copy to: _____Custodian _____Bldg Principal _____Room Instructor _____Group Using Bldg
Hellgate Elementary
Page 1
March 3, 2008
BUILDING USE INFORMATION
Generally, there is no charge for the use of the facilities if the custodians are on normal duty hours. However, if the facilities are used when a custodian is not scheduled to be at work, the charge will be that which is set by district administration. (There will be a two-hour minimum charge.) Fee information is available at the office. It is understood by the requestor, that charges for the use of the facilities can be made or increased by prior notice. The organization sponsors named on the reverse side, who have requested the use of the building for the specified time, hereby agree to accept the responsibility for any damage incurred during the time of use. It is understood that the custodian or person delegated by the Superintendent will be present at all functions and is in authority. He/she will be instructed to see that the building and equipment are properly used. Use of the buildings is restricted to community groups. There must be a majority of community people in any group requesting use. Groups requesting use of the buildings should be prepared, if requested, to submit a list of names and addresses of individuals in the group. Exceptions to this requirement will be considered by the superintendent. If a school function is scheduled for the same time and place as a regularly scheduled community activity, the school function will take priority. Failure to keep off of folded bleachers will result in loss of building use. I have read the above information: ________________________________________________ Fees/charges due___________________________________________. For:_____________________________________________________ ______________________________________________________
For Office Use - Custodian, please complete: Group using bldg: Custodian Responsible: Time In_______________Time Out________________Approx. Number Attending_______________ Name___________________________________________________________________________ Hours Worked, if after regular hours:____________________________________________________
Hellgate Elementary
Page 2
March 3, 2008
Building use – Details
To better prepare for your request to use our school facilities and equipment, please complete the following:
What time does your group plan to ENTER THE BUILDING __________ EXIT THE BUILDING___________
Which Room(s) to you wish to have access to during your event: Commons (Lunchroom) Locker Rooms Gym
ONLY Room (s) and/or Equipment requested will be made available for your use. TIMES listed will be strictly observed.
Other (Please be specific)__________________________________________________________________ Usage Fee $50/per custodial hour (Total due to be determined by administration) – Total $____________
What type of Equipment do you wish to have access to during your event: Lunch Tables/Benches (regular lunchroom set-up) Chairs – how many?______ 2’x6’ Tables – how many?_______ PA System
Other (please be specific)__________________________________________________________________ Equipment Usage Fee $_________ (to be determined by administration) Room Usage Fee + Equipment Usage Fee = $____________ Total Due
Please outline any details in regards to set-up or expectations you foresee occurring for your event to be a success. Include drawn maps if necessary._______________________________________________________
Hellgate Elementary
Page 3
March 3, 2008
It is hereby agreed that:
Hellgate Elementary encourages the use its facilities by the public. However, it is a district policy to give priority to the student use of the facilities. In this request, the right to cancel a facility use opportunity is reserved by the school district. The use of the property shall be supervised by an adequate number of adult sponsors to assure proper care and use of the facility. It is agreed that all rules and regulations for the use of the facility will be complied with and that all damage to the building or its contents resulting from this use of the facility will be reimbursed to the district at the actual cost of repair or replacement. The undersigned organization, by signature of its authorized representative, hereby guarantees that the organization shall indemnify, defend and hold harmless Hellgate Elementary and any of it's employees or agents from any liability, expenses, costs (including attorney fees), damages and/or losses arising out of injuries or death to any person or persons or damage to any property of any kind in connection with the organization's use of the aforementioned school facility which are not the result of fraud, willful injury to a person or property, or the willful or negligent violation of a law. The undersigned further agrees to abide by non-discrimination clauses as contained in the Montana Human Rights Act and the Governmental Code of Fair Practices. The Lessee shall rent the above and only the above described facility at the agreed upon date(s) and time(s) for the described function. The Lessee agrees to pay actual fees and costs, which are estimated as follows, for the use of the facility. The actual fees and costs will be determined and calculated after the use of the facility is concluded. Estimated Rental Fees $___________________________ Estimated Personnel Fees $___________________________ Estimated Equipment Costs $___________________________ Total Estimated Fees and Costs $___________________________ The Lessee shall repair and make good all damages to the premises, which are caused by the Lessee’s use of the premises. The Lessee shall deposit sum of ___________________________ dollars ($_________________) with check or money order (no cash) on or before___________________, 20____. Said deposit shall be credited to the final statement of fees and costs due and owing under this agreement. The Lessee shall present to the Lessor proof of liability insurance coverage (unless waived by the Hellgate Elementary Board of Trustees). Said insurance shall provide for amounts not less than $1,000,000.00 for bodily injury or death to any one person, $1,000,000.00 for all bodily injuries and death resulting from any one accident and $1,000,000.00 for property damage in any one accident or the policy may provide a combined single limit for bodily injury and property damage of $1,000,000.00. Said certificate shall contain a provision that the insurer not cancel or refuse to renew without giving Hellgate Elementary written notice at least 10 days before the effective date of the cancellation or non-renewal.
Lessor – Hellgate Elementary
Lessee
Building Principal
Date
Authorized Representative Date Person shall be responsible for the rental/use and billing
Business Office Approval
Hellgate Elementary Page 4 March 3, 2008