FACILITIES USE FORM

Name of Applicant and/or OrganizationPhoneEmail Address

Name of Person ResponsiblePhonePurpose of Renting Facilities

Billing AddressCity, State, ZIP

Specific School/Building Requested:

Connell High School Olds Junior High School Basin City Elementary

Palouse Junction High School Connell Elementary Mesa Elementary

Specific Facility Requested:

Gymnasium Cafeteria Kitchen Classroom Library Auditorium Fields

Other

Specific Equipment Requested:

ProjectorChairsTables Lighting PA System Other

Will admission fees be charged at this event? Yes No

DATE(S) TO BE USED / Doors Unlocked / Start Time / End Time / Doors Locked

Please select which group best describes your organization:

Group A (school or child-related groups or community groups)

Group B (non-community and/or non-profit groups)

Group C (commercial enterprises for profit)

I have read and understand all CONDITIONS AND RESPONSIBILITEIS and INSURANCE COVERAGES specified in this Facilities Use Form packet. I am authorized to sign the agreement. / SCHOOL/BUILDING APPROVAL

Name of Applicant (please print)Building Principal (or designee) Signature

Applicant’s Signature DateDate

THE FOLLOWING INFORMATION TO BE COMPLETED BY DISTRICT PERSONNEL

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FACILITY RENTAL RATES
Category / A
School or child related groups or community groups / B
Non Community and/or Nonprofit groups / C
Commercial enterprises for profit
Multipurpose/cafeterias / NO CHARGE / $75.00 / $150.00
Kitchens / NO CHARGE / $50.00 / $100.00
Classrooms / NO CHARGE / $25.00 / $50.00
Gyms / NO CHARGE / $75.00 / $150.00
Computer Labs / NO CHARGE / $75.00 / $150.00
Fields / NO CHARGE / $25.00 / $50.00
Library / NO CHARGE / $50.00 / $100.00
Miscellaneous areas / NO CHARGE / $25.00 / $50.00
FEES:Wages for custodian, cooks, supervisory, technical, and other support personnel are in addition to the above fees and should be paid in accordance with the prevailing schedule and district policy. A charge shall be made for use of special equipment such as public address systems, projectors and stage equipment. All charges and fees are payable to the North Franklin School District upon billing. . North Franklin School District does not discriminate against persons who have a disability in any of its programs or activities. It is expected that organizes who rent District facilities will also provide programmatic access to any person with a disability who may wish to participate in their organization’s activities.
FAILURE TO ADVISE OF CANCELLATION WILL RESULT IN CHARGES FOR CUSTODIAN TIME EXPENDED

DEPOST RATES (only required for groups B & C)

Performing Arts, cafeterias, computer labs, gymnasiums, kitchens, etc., $300.00

Classrooms, miscellaneous areas, etc.$100.00

LABOR COST SCHEDULE (All rates are hourly and are based on 1.5 x regular rate.)

Cook23.79Custodial – Day Shift25.35

Cook’s Assistant21.45 Custodial – Swing Shift25.94

*Auditorium Manager (technical)Custodial – Graveyard Shift26.33

Straight Time21.15Maintenance Worker29.25

Overtime31.73

District staff required?Yes ___No ___

______(position) _____ hours @ $ ______per hour = ______

Keys Needed? Yes____No____

Date Keys checked out ______Signature of Lessee Representative______

Date Keys returned ______Signature of District Representative ______

Facility rental rate ______

Facility deposit rate ______

Total Fees Paid______Check Number______

Certificate of insurance required? Yes____ No_____ If yes, please attach.

M&O OFFICE USE ONLY
Irrigation Schedule Reviewed
Custodial Notified & Reviewed / DISTRIBUTION
Auditorium Mgr (Performing Arts Center)
Facility Director/Principal
Maintenance & Operations
On-Site Custodial
Food Service

Use of School Facilities

  • The board subscribes to the belief that public schools are owned and operated by and for its patrons. The public is encouraged to use school facilities but shall be expected to reimburse the district for such use and ensure that funds intended for education are not used for other purposes.
  • All applicants for use of school facilities shall hold the district free and without harm from any loss of damage, liability or expense that may arise during or be caused in any way by such use or occupancy of school facilities. Also, in the event that property loss or damage is incurred during such use or occupancy, the amount of damage shall be decided by the superintendent and approved by the board and a bill for damages shall be presented to the group using or occupying the facility during the time the loss or damage was sustained.
  • Sponsoring organizations shall provide sufficient, competent adult and/or special supervision, and the amount of adequate supervision shall be agreed upon at the time the authorization is issued. The superintendent possesses the authority to make the final decision on use of school facilities by a group. The group may appeal such decision to the board.
  • Because of the value of district’s playing fields to the community’s total recreation opportunity, the field may be used by all residents. The use must be appropriate and compatible with each play field and its surrounding area. Such use shall not result in destruction, damages, or undue wear or pose a hazard to children or others. Activities which endanger others or cause damage to fields and lawns are restricted. Should damage to fields and lawns occur, the Superintendent shall make reasonable effort to obtain restitution for the damage.
  • If a kitchen is used for the preparation or serving of food, except the making of coffee or just the serving of food, a food services employee must be on duty during such preparation and serving. The District shall be reimbursed by the organization for the time of this lunchroom employee.
  • When a food services employee is require, he/she shall offer such assistance as may be necessary to assure proper use of District equipment and facilities, and will assist those using the facilities in their preparation and serving of foods and in cleaning up the area. It is to be understood that the actual preparation and serving are the responsibility of the organization’s kitchen committee and that the employee is there to supervise and assist.
  • Since District cafeterias and kitchens are considered public eating places it is necessary that rather rigid rules and regulations be followed when they are used. The following rules shall be observed in the use of school kitchen or cafeteria facilities:
  • When an organization uses the kitchen for the preparation of light refreshments (coffee, tea, punch, pie, cookies, etc.), no food services employee needs to be present. The dishes and silver shall be washed in the sink or dish washer and the entire kitchen area shall be left in an orderly fashion. The organization may use the school’s automatic coffee maker if one is available, but must supply all coffee, cream, sugar, etc.
  • For use of kitchen or cafeteria facilities other then the preparation and serving of light refreshments, the regular School District regulations the use of cafeteria or kitchen facilities shall be observed.
  • A custodian or other authorized staff member must be on the premises when any non school group is using school facilities. (*No cost for custodian opening/closing facility during regular shift hours.) An authorized staff member (state manager), or other person designated by the Superintendent, must operate the light and/or sound system of the Performing Arts Center.
  • District-sponsored activities, including curricular and co-curricular functions, retain first priority in use of facilities. Authorization for use of school facilities shall not be considered as endorsement of or approval of the activity, group or organization, nor the purposes it represents. School facilities shall be made available to church groups on a short-term basis and shall not be rented as a permanent place of worship. Alcohol and tobacco are strictly prohibited on all school facilities at all times.
  • The district does not assume any responsibility for thefts or damages of property of any user and does not agree to furnish any supplies, services, or facilities which are above the normal and reasonable use expectations.
  • When no service charge is made, the applicant or organization agrees to clean the facilities and restore the equipment/furniture to its original arrangement. Only the facilities listed in the application will be used by the applicant’s group. Alcohol and tobacco are prohibited in all school buildings. Groups or individuals using school facilities accept responsibility for enforcement of this rule. The School District reserves the right to cancel, upon short notice, any meeting or activity in any School District facility.
  • The applicant shall be held responsible for charges incurred as a result of damage to said facilities and, if requested, may be required to furnish proof of liability insurance in amounts of not less than $100,000/$300,000 bodily injury liability and $25,000/$25,000 property damage (such policy shall acknowledge that the Hold Harmless clause contained in this agreement is insured therein).

FACILITY EXPECTATIONS

  • Only non-marking gym shoes on gym floors. No street shoes on gym floors.
  • No cleats or spikes in any facility.
  • No gum, pop or candy in gym at all times. Only water allowed.
  • Clean up spills immediately due to sensitivity of the wood to water reaction.
  • Do not drag any sharp objects across the gym floor.
  • Protect gym floor from any potential damage. No chairs – PE equipment or any other equipment without proper glides & floor protection. i.e.; hockey sticks & goals – and please do not drag across floor.
  • Athletic Facility & Locker Rooms -Teams should pick up garbage and put in provided trash cans, along with clothes.
  • No soccer balls, softballs, or baseballs in gyms as it damagesthe walls – ceilings – lighting – scoreboards.
  • No baseball/softball practice.
  • Only approved tape on gym floors-Maintenance & Operations will provide.
  • No keys should be given to kids and no operating motorized equipment in gyms. i.e. bleachers – baskets etc.
  • Follow all bleacher operation procedures. Only three people to pull Gym#2 bleachers out – damage is constant with too many people operating.
  • Supervision and security of the doors need to be consistent.
  • Secure all exterior doors at Athletic Facility.
  • Please stay out of custodial rooms.
  • If you have to borrow products or equipment, please clean up and put back. Equipment should be left in same condition you found it in.

HOLD HARMLESS AGREEMENT

I, ______, hereby request the use of the facilities of the North Franklin School District and agree to abide by the District rules and regulations established pursuant thereto relating to the facility use. I agree to keep the facility clean and in order condition, and also agree to be responsible for any damages by my activities or use.

I understand that the Facility Use Agreement is non-transferable. North Franklin School District reserves the right to change or cancel any or part of the Agreement. North Franklin School District shall not be liable to the facility use for any damage to persons or property resulting from the negligence of other, or for any damage to persons or property resulting from the condition of the premises or other cause.

Facility user agrees to indemnify and hold harmless North Franklin School District against and from all claims by or on behalf of any person, firm, or corporation arising out of or connected in any ways with the facility user’s use of the facility, or arising out of or connected with any act of negligence or omission of the facility user, or any of its agents, servants, or employees. In case of action or proceeding brought against the District by reason of such claim, the District may, at its option, require the facility user to resist or defend such action or proceeding at facility user’s own cost and expense by counsel reasonably satisfactory to the District.

Applicant’s Signature ______Date ______

Address ______ Phone ______

North Franklin School District

NEW CONCUSSION LAW REQUIREMENTS

Private Non-Profit Youth Sports Groups

HB1824, otherwise known as the Zachery Lystedt Law, was signed into law on May 14, 2009. It requires, as of July 26, 2009, that additional steps be taken regarding concussions in school athletic programs and private non-profit youth athletic programs using school district facilities.

This bill requires training and documentation which schools must adhere to. This pertains to private non-profit youth sports groups using school district facilities as well as school teams. As of July 26, 2009 all school coaches, players, and their parents/guardians must meet these minimum requirements:

1. All school coaches will have to take training on the nature and risk of concussions and head injury including continuing to play after a concussion or head injury.

2. On a yearly basis, a concussion and head injury information sheet shall be signed and returned by the youth athlete and athlete’s parents/guardian prior to the youth athlete’s initiating practice or competition.

3. All athletes suspected of suffering a concussion or brain injury will be removed from practice or competition and not returned to play until cleared in writing by a licensed health care provider trained in the evaluation and management of concussions (Medical Doctors, Doctor of Osteopathy, Advanced Registered Nurse Practitioner, Physicians Assistants, and Certified Athletic Trainers).

4. All private non-profit youth sports groups using school facilities shall:

  • Provide the school with written proof of insurance covering their youth athletes with limits required by the law. [The North Franklin School District requires certification of not less than one hundred thousand dollars ($100,000).] and,
  • All coaches, players and parents of private non-profit youth teams shall have similar training as outlined for school coaches, players, and parents prior to the start of any practice and,
  • The private non-profit youth sports groups shall submit a statement of compliance with the insurance coverage and required head injury trainings prior to receiving access to school facilities.

NORTH FRANKLIN SCHOOL DISTRICT

Compliance Statement for HB 1824, Youth Sports-Head Injury Polices and

SB 5803, Sudden Cardiac Arrest Awareness

______, a private non-profit youth sports group, verifies all coaches, athletes and their parent/guardian have complied with mandated policies for the management of concussions and head injuries as prescribed by HB 1824, section 2 and Sudden Cardiac Arrest Awareness as prescribed by SB 5803, section 3.

Attached is a proof of insurance under an accident and liability policy issued by an insurance company authorized to do business in Washington State covering any injury or damage with at least $50,000 due to bodily injury or death or one person and at least $100,000 due to bodily injury or death to two or more persons.

Signed:

______

Representative of Private/Non-Private Organization (Date)

______

Name PrintedPosition with Organization

*Note: Access to school facilities may not be granted until all requirements of this application are complete and approved by the school district &/or designee.

Revised 8/18/15