Public Schools Facilities Use 2024-2025

DIRECTOR/PRESIDENT/GROUP LEADER

Organization Name	---
Organization Type	Non Profit (501c3)
EIN/Tax #	99-2026822
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	12
Leader's Name	---
Leader's Phone Number	+16172120500
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	2025-01-17 - 2025-03-08
Days of the week	Wednesday, Friday
Times	5:30 - 6:30

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?

No

Indemnification/Hold Harmless

Name of Director/President/Group Leader:	---
Date	2025-01-14
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	2025-01-14
I understand that I am completing a binding electronic signature when I submit this form constitutes a legal signature.	Yes