Pope High School Performing Arts Center Facility Request Form

Date of request: Requesting person:

Event name: Organization:

Number of attendees: Is this a change to a previous request? Yes No

Event start date: Event end date: Cell Number:

Set up start time / Event start time / Event end time / What time will the last people leave?

Does this event support a Pope organization booster club? Which organization? Donation amount?

CCSD supervision is required for all events.

Is this a CCSD event?

If this is a non-CCSD event, CCSD supervision will be provided. Your organization is financially responsible for the CCSD supervision, as detailed in the Pope Performing Arts Center Fee Schedule.

Please initial here to indicate and accept your understanding of supervision requirements:

Technical and Stage Equipment

Use of technical and stage equipment is subject to rental fees and technical assistance fees as detailed in the fee schedule.

Please indicate any technical needs:

Sound system Handheld microphone How many? 2Microphone Stand

Wireless headset microphone? How many?

Stage lights, general Stage lights, specials

Other

Please indicate any stage equipment/furniture needs:

Piano Standing choral risers How many?

Seated choral risers How many? Chairs How many?

Music stands How many? Director’s PodiumLectern

Other

Heating and AC runs Monday through Friday from 6:30am until 4:30pm. Please indicate if you need additional heating or AC.

Time Heat/AC On / AMPM / Time Heat/AC Off / AMPM

Please indicate additional needs:

Security campus police (fees incurred): Custodial assistance during school hours:

Custodial assistance during non-school hours (fees incurred):

Comments:

By submitting this form, organizations agree to reimburse Pope High School or the Cobb County School District for any costs associated with your event. This may include damage done to any facility as a result of failing to secure the building or supervise attendees. The PHS administration reserves the right to move or reschedule events. Every attempt will be made to notify the event planners. Organizers not affiliated with Pope High School must complete a Facility Use Contract.

This form must be completed and turned in to Zelda Johns () at least two weeks before the scheduled event.

______

Approval SignatureDate

Mathews Vorobel Johns Gribble Rudolph Benton Holman