Facility Use Request Form

FACILITY USE REQUEST FORM

Please use this form to request use of Augusta School District facilities.

ALL USERS/GROUPS AND THEIR REPRESENTATIVES ACKNOWLEDGE ALL TERMS/CONDITIONS OF THE SCHOOL DISTRICT OF AUGUSTA, POLICY 7510 - USE OF DISTRICT FACILITIES.

Alcoholic beverages may not be served. No food is allowed in the gym or pool areas.
Pool use is only allowed when a certified lifeguard is on duty.
Kitchen users/groups and their representatives acknowledge all terms/conditions of the Kitchen Usage Agreement.

FACILITY USE FEES

Multiple fees may be required for use of facilities, and will be determined on a case-by-case basis. Personnel needs will be determined by the District and will be charged to the user/group.

USER/GROUP BASE FEE	FEE
Augusta School District	$0
City of Augusta/Townships	$0
Augusta Non-Profit Organizations	$0
All Other Non-Profit Organizations	$25
All Other Users/Groups	$40

PERSONNEL FEE	FEE
Custodian	$30/hour
Foodservice	$25/hour
Lifeguard	$8/hour
Media Specialist	$48/hour

ADDITIONAL FEE	FEE
Kitchen ($10 non-refundable/$30 refunded upon satisfactory inspection)	$40
Pool - 8 swimmers or less	$25
Pool - 9 swimmers or more	$3/swimmer
Key/Access Card (refunded upon return)	$40

USER/GROUP INFORMATION
Name of User/Group:*
Contact Person:*

First NameLast Name
E-mail:*
Phone:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
STATEMENT OF RESPONSIBILITY/HOLD HARMLESS AGREEMENT

The above-named organization agrees to abide by the Augusta School District policies and procedures that apply to use of this space. We assume the responsibility of clean up and guarantee payment for any damages. We agree to defend, indemnify and hold harmless the School District of Augusta from and against any and all liability, loss, damages, claims or actions (including costs and attorney's fees) for bodily injury and/or property damage, to the extent permissible by law, arising out of or in connections with the actual or proposed use of District property, facilities and/or services.
Signature of Authorized User/Group Representative*

Clear
I have read the regulations and do hereby certify that I have been duly authorized by the above-named group, administrator in charge, or organization which I represent to enter into this agreement, and that the activity which the group, administrator in charge, or organization is sponsoring fully meets the conditions set herein and that we agree to observe all rules and procedures as stated.
Should be Empty:

FACILITY USE REQUEST FORM

FACILITY USE REQUEST DETAILS

USER/GROUP INFORMATION

STATEMENT OF RESPONSIBILITY/HOLD HARMLESS AGREEMENT