APPLICATION FOR SCHOOL BUILDING & GROUNDS USE
DAVID CITY PUBLIC SCHOOLS

* Required Fields

Today's Date:   *

Name of Organization:

Applicant:   *
E-mail Address: *

Building Requested: *
ELEMENTARY:   Classroom   Multi-Purpose Room
BELLWOOD:       Classroom  Multi-Purpose Room
HIGH SCHOOL:   Classroom Activities Center  Lower Gym

Room Name/Number:   *

Frequency of Use: *

Date of Use: *  Hours of use: *

Equipment Needed:

Kitchen Equipment Needed:

Purpose:

Admission That Will Be Charged:

Proceeds Used For:

I, the undersigned, do hereby affirm and take responsibility for the following on behalf on myself or the  sponsoring organization:

1.    The applicant is responsible for any and all liability claims resulting from the applicant's use of a public school building. The School District of David City is not liable for any claims resulting therefrom.

2.    State Law forbids the possession or consumption of any alcoholic beverages upon the premises.

3.    The Board of Education reserves the right to refuse to rental or scheduling to any group, organization or business which fails to provide necessary control or policing of facilities.

4.    Any damage to premises or breakage of equipment will be paid for the by scheduling party.

5.    If kitchens are to be used, a cook must be present. Kitchens must be left clean and in usable conditions.

6.    Preference on scheduling will be first to schools, school district organizations, then, community organizations and businesses.

7.    No event will be considered scheduled until this form has been completed and return to the Superintendent's Office and validated by the Superintendent of Schools.

8.    An adult supervisor will be required for any youth program.

9.    Fees charged will be determined by Board Policy. Fees include only room/facility and does not include necessary equipment or additional custodial time.

10.    Checks for fees shall be made out to the David City Public Schools and are preferably due in advance but not later than a date set by the Superintendent of Schools.