School Facility Usage Application Form

PLEASE NOTE APPLICATION DEADLINE IS MAY 15.
Confirmations are normally not received until mid-September.

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Name of Group:

First Contact:

Full Mailing Address:

Telephone:

Enter a valid phone number. Example: 123-456-7890

Second Contact:

Full Mailing Address:

Telephone:

Enter a valid phone number. Example: 123-456-7890

School(s) requested:

Type of facility required (gym/auditorium/cafeteria):

Size requirement of facility:

Please provide a brief description of program:

Day(s) of the week:

Hour(s) From - to:

Proposed start & end date:

Age of participants:

Children (under 18 yrs.)

Adults

Number of participants:

Does the instructor receive remuneration for his/her services?

Yes

Is there a cost for the program? Explain (please provide fee structure)

Do you have any special events/tournaments planned this year? (If so, please provide dates or approximate dates & times and any special requirements)

Does your group carry its own liability insurance? (If so, please attach a copy)

Yes

Please attach liability insurance document if applicable.