HEAD-ROYCE FAMILY

THE HEAD-ROYCE SCHOOL

FACILITIES USE PERMIT APPLICATION

Date: ______

Name:______

Address:______

City:______

Phone:Home: ______Business: ______

Email Address: ______

REQUEST PRIMARY USE OF:

Upper Tennis Courts Upper Basketball Courts

Upper Field

*PLEASE NOTE THAT FOR LIABILITY REASONS, THE SWIMMING POOL MAY ONLY BE USED FOR SCHOOL-RELATED ACTIVITIES.*

Please list the names of those adultsrequesting a permit card:

ACCESS POINT:From which point do you wish to enter the HRS Campus?

Rear Gate on Whittle Avenue Main Gate on Lincoln Avenue

(Pedestrian Access Only)

In the event that your gate card is lost or stolen, card holders must advise the Business Office immediately so that the card may be deactivated. The cost for a replacement gate card is $25.00.

FACILITY USE PERMIT GUIDELINES

  • These facilities are for personal use only – no organized groups. Proof of residence in the residential permit parking zone is required.
  • You are hereby granted permission to use School property. However, if this includes walking your pets, you are responsible for cleaning up after them.
  • Please note that firstpriority use of these facilities is granted to Head-Royce administrators, faculty and staff.
  • When School events or games are in progress, the campus facilities will not be available for neighbor use.

ASSUMPTION OF RISK & LIABILITY

I am aware that while using the Head-Royce facilities, by arrangement with The Head-Royce School, certain risks and dangers may occur. These may include, but are not limited to, the hazards of play, field and play surfaces and structures, or access to and from the facility.

In consideration of the right to use the Head-Royce facilities and the services arranged, I/we assume all the above-mentioned risks and will hold The Head-Royce School and the staff members in charge, harmless from any and all liabilities, actions, causes of action, debts, claims, and demands of every kind, and nature whatsoever, in connection with my/our use of the Head-Royce facilities arranged by the Head-Royce School. The terms, hereof, shall serve as a release and assumption of risk for all members petitioning for the use of the Head-Royce facilities.

Signature: ______Date: ______

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

FOR HEAD-ROYCE USE ONLY:

The Head-Royce School authorizes ______

useof the facilities on a self-scheduling basis.

Dennis G. Malone

CFO/Director of Operations

Head-Royce School

DGM:SEE:09/28/16

All gate cards will be deactivated on June 30th of each year. Please contact the Business Office at after July 1st in order to have your card activated once again.