905.01E1 REQUEST FORM FOR THE USE OF SCHOOL FACILITIES

Any party who is requesting use of school facilities should complete the request form attached.  It will be the responsibility of the party desiring the use of school facilities to obtain from the superintendent of schools or designee, the approximate costs, if any, connected with such use and accept the charges imposed by the school district when payment is to be made.

The superintendent has the authority to approve of requests covered by Board Policy.  All other requests must go before the Board of Education for their approval.

The superintendent or designee will confirm all arrangements in writing which have been approved for use of facilities.  The school will bill the party for any obligated costs following use of the facilities and payments due are to be made through the office of the superintendent of schools. If due to unforeseen circumstances rescheduling is necessary, only district activities may move a previous scheduled activity to another date. 

Tournament pay will be $20.00 per hour plus the costs of custodial fees for the event.  This fee will be waived if the organization provides a donation equal to or more than the cost of rent excluding custodial fees. Use of the Middle School gym will follow Board Policy and central office procedures.  905.1E1 (The Tipton Middle School gymnasium is the school district’s main competition gym.  Its use will be exclusively for school district purposes. The superintendent may waive this for special circumstances if the need serves a community or school district purpose).

It shall be the responsibility of the superintendent to develop a procedure for the scheduling of school facilities.

The undersigned entity makes an application for the use of the school district faility or equipment as designated below.  The entity will provide police protection at its own expense, if necessary, to maintain order and to properly protect the building, site or equipment.

 

 

 

 

 

 

 

 

 

 

 

Code No. 905.1E1

Page 2 of 2

TIPTON COMMUNITY SCHOOL

REQUEST FORM FOR THE USE OF SCHOOL FACILITIES & EQUIPMENT

 

 NAME OF PERSON MAKING THE REQUEST _____________________________________________

ADDRESS ____________________________________________________________________________

PHONE NO. ______________________ E-MAIL ____________________________________

IF REPRESENTING AN ORGANIZATION OR COMPANY PLEASE INDICATE:__________________________________________

FACILITY BEING REQUESTED FOR USE:  _________________________________________________________________

PURPOSE FOR WHICH FACILITY IS TO BE USED:___________________________________________________________

DATE(S) THE FACILITY IS TO BE USED: ____________________________________

ACTUAL TIME EVENT BEGINS - ENDS: __________________________________________________________________________

TIME THAT THE FACILITY SHOULD BE OPENED: _______________________________________

ANY SPECIAL ARRANGEMENTS NEEDED?  ___________________________________________________________________

ANY SCHOOL EQUIPMENT (OTHER THAN DESKS, CHAIRS, TABLES) THAT YOU NEED?  ______________________________

  • DOES THE REQUEST INCLUDE THE USE OF KITCHEN FACILITIES? ________ 
  • DO YOU AGREE TO OBSERVE THE NO SMOKING AREAS AND NOT BRING ALCOHOLIC BEVERAGES OR ILLEGAL SUBSTANCES ON THE PREMISES? ________
  • DO YOU AGREE TO PAY FOR ANY DAMAGES OCCURRING TO SCHOOL PROPERTY DUE TO YOUR USE OF THE SCHOOL FACILITIES? _________
  • DO YOU AGREE TO ACCEPT THE LIABILITY FOR ANY ACCIDENTS OR INJURIES TO THOSE IN ATTENDANCE AT YOUR REQUEST OR INVITATION TO THE MEETING, FUNCTION, ETC. FOR WHICH YOU ARE HERE IN REQUESTING THE USE OF SCHOOL FACILITIES? ____________________

OFFICE USE

 Facility Use Fee = $_________                           SIGNED BY:____________________________________________

Kitchen Use Fee = $_________                           DATE REQUEST FILED: ___________________________

&/or Supervisor Fee = $_________

Cleaning Fee (TBD) = $_________                      SCHOOL OFFICIAL APPROVING: ____________________________

Personnel Costs (TBD) = $__________               NOTE: Cleaning/personnel costs TBD following event.

Fees Payable Following Event:  _______________________

Approved:  12/17/2015                     Reviewed:  5/10/2021               Revised  5/10/2021