Northern Cambria School District

Providing a Quality Educational Environment

Name of Organization:

Address:
 

Phone number: 

Responsible Representative
Name

Email:

Address: 

Contact Phone: 

Hereby makes application for use of school facilities as follows:

Date Requested: 

Time(s) Requested:

Building / Room: 

StadiumEMS AuditoriumHS AuditoriumHighschool GymPoolE/MS Cafeteria (dining area)Elementary/Middle Main GymElementary/Middle Aux. GymHS Cafeteria (dining area)Central Admin. Conference RoomOther, Please Specify Below

Estimated Attendance:

Specific Purpose of Use:

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

Equipment Requested:
Stage Lights / OperatorLectern / PA system OperatorShowers - Dressing Rooms (Girls)Showers - Dressing Rooms (Boys)PianoTables/ ChairsAV Equipment / Operator

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.