Public Schools Facilities Use 2024-2025

DIRECTOR/PRESIDENT/GROUP LEADER

Organization Name	---
Organization Type	Non Profit (501c3)
Contact Person	---
Address	---
Cell Phone	---
Email Address	---
Additional contact person	---
Cell phone number of additional person	---

EVENT INFORMATION

Event/Activity Name	---
Primary Participants	Youth
Total Estimated Number of Participants	30
Leader's Name	---
Leader's Phone Number	+19286516552
Brief Description of Event (please be as thorough as possible)	---
School	---
Space needed	---
Do you require equipment or setup?	---

First Preference For Event Date/Time

Is this event happening on one date or multiple dates?

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First preference: Seasonal

Dates	2025-09-30 - 2025-06-12
Days of the week	Tuesday, Thursday
Times	4:00pm-6:00pm

Second Preference?

If your first choice date is not available, do you have a second choice?

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Second Preference information

Days of the week

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Additional Questions

Will food be served?	Yes
Please explain, what kind of food, how will it stored, will it be homecooked or store bought, etc.	There will be small snacks given during the 2 hour program. We take an insulated book bag where we take fruit such as apples or other small snacks such as cheese sticks.

Food Waiver

Name of Director/President/Group Leader:	---
Date	2024-08-19
I understand that I am completing a binding electronic signature when I submit this form constitutes a legal signature.	Yes

Indemnification/Hold Harmless

Name of Director/President/Group Leader:	---
Date	2024-08-19
I understand that I am completing a binding electronic signature when I submit this form constitutes a legal signature.	---

Rules and Regulations

Name of Director/President/Group Leader:	---
Date	2024-08-19
I understand that I am completing a binding electronic signature when I submit this form constitutes a legal signature.	Yes