Use of Facilities Request

Use of Facilities

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.

Name of Organization:


Phone number: 

Responsible Representative


Contact Phone: 

Hereby makes application for use of school facilities as follows:

Date 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:


Security Measure