Facilities Request - Rice Lake Middle School

Facilities Request - Rice Lake Middle School

Contact Information:  (Items marked with * and shaded in blue are required)

*Name of Organization

*Person Responsible

*Phone

*Event Supervisor

*Email (Event Supervisor)

 

Fax:

Address:

City/State/Zip:

If Person Submitting This Form is different that Event Supervisor, please enter your:

Phone:  *

Email:   *

Email Addresses of Others to Receive Copies of Facility Permit/Contract:

Activity Information:

*Name of Activity:

Describe, in detail, what you will use the facility for

First Date/Time Combination Requested:  (One or more dates at the same time of day)

*Dates:

*Entering Facility Time:   *AM/PM:

*Activity Begin Time:      *AM/PM:

*Activity End Time:       *AM/PM

*Exit Facility Time:       *AM/PM:

Second Date/Time Combination Requested:  (One or more dates at the same time of day)

Dates:

Entering Facility Time:  AM/PM:

Activity Begin Time:     AM/PM:

Activity End Time:      AM/PM:

Exit Facility Time:       AM/PM:

Additional Dates and Times Needed:


*Expected Attendance (Number):

*Admission Fee Adult/Child 
(The Superintendent may adjust rental rates when fees or ticket prices exceed the normal and customary charges):

Tax Exempt Number (non-profit group only)

*Space/Room(s) Requested at this facility: (View applicable Facility Use Regulations and Fees)

*Equipment Requested(includes technology, audio, and visual equipment):  
    Note - You are expected to bring your own computer unless otherwise indicated here 
    
(View applicable Facility Use Regulations and Fees)

*Will Concessions be Sold?(Contact the school for concessions requirements)

No   Yes

*General Information/Clarification/Special Needs:  
(i.e.  Food Services, Special Access, Library Media Technical Support, Custodial Services, etc)

 Note:  Charges may apply for support services including custodial services and auditorium sound system support
(See Facility Use Regulations and Fees)

Other information or comments:

Exemption Request:
Complete the following if your organization is requestion an exemption from the applicable rental fee.

Purpose(s)  or goal(s) of group/organization:

Type(s) of Service Provided the Rice Lake Area Community and/or Rice Lake Area School District:

Why should the Board of Education grant your request for an exemption from the rental fee charged a typical group/organization in your rental fee category?:

What percentage of the members of your group or organization are residents of the Rice Lake Area School District?

Acceptance of Responsibility:
I have read and understand Rice Lake Area School District Board of Education policy 830 and its associated rule regarding the use of school facilities and policy 731.3 and its associated rule regarding building key/access card control.  I agree to abide by the terms and conditions set forth in these policies and their associated rules.  I understand that failure to comply with any Rice Lake Area School District Board of Education policy may result in the denial of future facility use requests.  Furthermore, I understand that by accessing the Rice Lake Area School District facilities I am accepting full responsibility for those facilities and their contents while I have access and may be held liable for any damages incurred (directly or indirectly) as a result of my access

*Accept:  

-------------------------------------------- FOR OFFICE USE ONLY ------------------------------

1. Door Lock Details:  

2Custodians - Will they be hired for this event, etc?  (Provide details) 

3.  Special Instructions:  

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