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 , Adults
Total Estimated Number of Participants	25
Leader's Name	---
Leader's Phone Number	+16172120500
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: Two or More Dates

Dates	---
Days of the week	Monday
Times	5PM - 7PM

Second Preference?

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

---

Second Preference information

Days of the week	---
Times	---
Location	---

Additional Questions

Will food be served?

No

Indemnification/Hold Harmless

Name of Director/President/Group Leader:	---
Date	2024-09-29
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	2024-09-29
I understand that I am completing a binding electronic signature when I submit this form constitutes a legal signature.	Yes