FILE:  KG-E2 

APPLICATION TO USE SCHOOL FACILITIES

_______________________________________________________________________________________________

Name of School                                                                                                                                        Telephone   # 

_______________________________________________________________________________________________

Organization Requesting Facility

_______________________________________________________________________________________________

Reason for Request

______________________________________________________________________________________________

Signature of Person Responsible                                                                                                          Telephone#

__________________________________________________________________         Time:  From  _______________

Facility Requested                                                                                            Date (s)                                    To _______________

FACILITIES NOT AVAILABLE DURING HOLIDAYS.

Specify Area To Be Used:

Stadium                  _____        

Gym                        _____       

Auditorium              _____

Cafeteria                _____       

Other                       _____          

Specify Other ___________________________

If kitchen area cannot be locked, a cafeteria worker must be present at all times and compensated accordingly.

Police Protection Required:  Number Policemen Needed _____________

(School will arrange for security, but organization will pay policeman)

$1,000,000 Liability Insurance required naming WPSS as certificate holder.

____Approved ____Not Approved ____________________________________Date____________

                                                                Signature of Principal

      _Approved ____Not Approved ________________________     _ _____    _Date____________

                                                              Signature of Superintendent

Fee Schedule:   (Waiver can be approved by Superintendent)

Security Deposit                           $100 Nonrefundable                                                         $_________

Use of facility (1 day)                    $300                                                                                   $_________

Use of facility (3 day max)            $500                                                                                   $_________

Additional days                             $100/day                                                                            $_________

Custodial/Cafeteria/                      $  40 for first hour; $15 each additional hour                 $_________

Any other school employee or $ 40 for each trip if only to lock or unlock door(s)

Use of school sound system         $  25  (Group must provide 9 volt battery for                 $_________

                                                              microphone)

Use of school podium                   $  25                                                                                   $_________

                                                                                            TOTAL AMOUNT DUE                 $_________

Washington Parish School Board