Admin

Use of Facilities Request

Use of Facilities

Name of Organization:

 

Address:
 

Phone number: 


Responsible Representative

Address: 

Contact Phone: 


Hereby makes application for use of school facilities as follows:

Date Requested: 

Time(s) Requested:

Building / Room: 

Estimated Attendance:

Specific Purpose of Use:

Will an admission fee be charged or a donation accepted?
NoYes             If So, Amount 

Equipment Requested:

Additional Information:

STATEMENT OF RESPONSIBILITY

I/We, the undersigned, have read the Northern Cambria School District's regulations concerning the use of school property and agree to assume the responsibility of any/all property damages incurred beyond ordinary usage. I/we assume all responsibility for any personal damage or liability incurred through use of he school facilities, and relieved the Board of School Directors from and responsibility for such claim.

I/We agree.



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