Public Schools Facilities Use 2024-2025

DIRECTOR/PRESIDENT/GROUP LEADER

Organization Name	---
Organization Type	Internal (City Hall, Chelsea Public Schools)
Contact Person	---
Address	---
Cell Phone	---
Email Address	---
Additional contact person	---
Cell phone number of additional person	---

EVENT INFORMATION

Event/Activity Name	---
Primary Participants	Adults
Total Estimated Number of Participants	10
Leader's Name	---
Leader's Phone Number	+16176718403
Brief Description of Event (please be as thorough as possible)	---
School	---
Space needed	---
If you selected classrooms, how many will be needed?	---
Do you require equipment or setup?	---
Please specify what equipment you need/set-up	---

First Preference For Event Date/Time

Is this event happening on one date or multiple dates?

---

First preference: Single Date

Date	2024-11-26
Day of the week	Tuesday
Total Time requested (ex. 4:00pm-7:30pm)	---
Set-up Time (ex. 4:00pm-5:00pm)	---
Event Time (ex. 5:00pm-7:00pm)	---
Breakdown Time (ex. 7:00pm-7:30pm)	8.30pm

Second Preference?

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

---

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.	we'll probably serve sandwich or pizza

Food Waiver

Name of Director/President/Group Leader:	---
Date	2024-09-25
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	2024-09-25
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	2024-09-25
I understand that I am completing a binding electronic signature when I submit this form constitutes a legal signature.	Yes