Belton School Dist #124

 

Request for Use of District Facilities      

Date Form Completed: Date Received at Central Office:  
Name: Address 1: Phone:
Email:  Address 2:
with  (Organization)  has permission to use the following area(s):
 (Area) @  (Charge)

(See HERE for charges)
 (Area) @  (Charge) at   
                   (School)
on  . (Dates(s)   will be in charge of the group.
       Name of Person Responsible
 
 Alternate Contact Person   Alternate Phone Number
 
 Send Invoice to:

  Name   Street Address   City        State   Zip
Description of Event: (If additional space is required, please use a separate sheet of paper and attach to this form.)




Time Doors open for set up Estimated Attendance 
Time Event Starts If equipment is needed, contact Facilities Office
Time Event is over immediately at:  (816) 348-1190.
Time Doors locked after clean-up
Will anything be sold? Please attach drawing if tables and chairs must
Is there an admission charge? be set up a specific way.
Custodial Fees -- At the overtime rate of $25.00 per hour.
Other Charges -- Use of PA, stage lights, chair set-up, audio-visual equipment, etc., at a rate of $15.00 per item plus operator charge at $15.00 per hour.
All charges are assessed every 3 hours with a 3 hour minimum.
 
A DEPOSIT EQUAL TO FIFTY PERCENT (50%) OF THE USAGE FEE MAY BE DUE AT THE TIME THE REQUEST IS APPROVED.  AFTER BEING
BILLED FOR THE EVENT, YOU HAVE 30 DAYS TO MAKE PAYMENT.  AFTER THAT A LATE FEE OF 5% OF THE TOTAL AMOUNT DUE WILL
BE ASSESSED AND MAY FORFEIT FUTURE USE.
Certificate of Insurance Received:
(See regulations V., F on reverse of this page)
Yes                                     No		 I HAVE READ AND DO UNDERSTAND THE REGULATIONS OF THE BOARD OF EDUCATION GOVERNING THE USE OF THE FACILITY, AND BY SIGNING THIS DOCUMENT DO AGREE TO COMPLY WITH THOSE RULES AND REGULATIONS.
Copies to:
Organization
Security
C.O./Support Services
Building Principal
Head Custodian		  
 
 
  (Signature of Person Making Request)
 
 (Building Approval and Calendar Confirmation)
   
 
 (Signature of Director of Finance/Support Services)
 

SEE HERE FOR IMPORTANT RULES GOVERNING USE OF SCHOOL PROPERTY AND GROUNDS.