Public Schools Facilities Use 2024-2025

DIRECTOR/PRESIDENT/GROUP LEADER

Organization Name	---
Organization Type	Community Group
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	25
Leader's Name	---
Leader's Phone Number	+16164439929
Brief Description of Event (please be as thorough as possible)	---
School	---
Space 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	2025-01-29
Day of the week	Wednesday
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)	7:00pm-8:00pm

Second Preference?

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

---

Additional Questions

Will food be served?

Yes

Food Waiver

Name of Director/President/Group Leader:	---
Date	2024-10-30
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	2024-10-30
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	2024-10-30
I understand that I am completing a binding electronic signature when I submit this form constitutes a legal signature.	Yes