Application for Use of School Facilities / Buses

APPLICATION FOR USE OF SCHOOL FACILITIES / BUSES

(If not enough space on the form below for Dates, Times and Areas Of Use please include an attachment.)

Waterloo Central School District

109 Washington Street PRINT FIRMLY Waterloo, New York 13165 (Form Revised 9.17)

Phone: 315-539-1500

School Building: ______Times needed: From: ______To: ______

Area(s) of Use: ______

Date(s) Requested: ______

Purpose of Use: ______

Services Required: ______

Will Admission be Charged? ______Amount: ______Use of Proceeds: ______

Organization Making Application: ______

Responsible Person in Attendance: ______Telephone: ______

Board of Education approval is required in advance for use of the buildings at times when custodians are not normally on duty. Charges or this custodial service will be billed to the group using the facilities. If the School District is operating under a contingent budget, additional costs incurred for facility use must be paid in advance by the requesting group. Certificate of Insurance is required of all groups, naming the school district as additional-insured and form CG2026 (supplementary information attached). See Board Policy 3280 and Administrative regulation 3280R for detailed information.

Requests involving the use of the various cafeteria kitchens and/or equipment are to be coordinated through the Cafeteria Manager. If cafeteria equipment is to be operated, at least one of the regular cafeteria staff members must be employed. Charges for this will also be billed tothe group using the facilities. Requests involving the use of physical education facilities need the approval of the Athletic Director. Requests forbuses need the approval of the Transportation Director. Requests for auditorium usage needs the approvalof the Auditorium Manager. Charges maybe assessed.

Please note that any profit realized from ticket sales or registration fees must be used for educational or charitable purposes. Board ofEducation approval is required for activities that require payment of fees or purchase of tickets.

Also, please note that Waterloo Central School District is a tobacco-free institution. Use of tobacco products of any form is strictly prohibited at all locations, including outdoor locations. Violators of the tobacco-free policy may be denied use of school facilities.

Signature of Person Making Application: ______Date: ______

Telephone: ______Email Address: ______

Name for Billing Purposes: ______Address:______

Approved /  Disapproved /  AED Coverage ______
(For All School Events) Name of person responsible for AED
______
Building Principal
______
Date / ______
Director of P.E./A.D., Cafeteria Manager,Transportation Director or
Auditorium Manager(If Required)
______
Date
______
Board of Education Approval (If on a weekend)
______
Date / White -Superintendent
Yellow- Building Principal
Pink - Facilities Manager
Gold - Dept. Manager(s)
Green -Person Making Application