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