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

Please note that multiple fees may apply for the use of facilities. The District office will calculate any applicable fees for your request and communicate them to you before approving this form.

For the current District facility fee schedule, please visit: District Facility Fee Schedule.

FACILITY USE REQUEST DETAILS
Name of Activity/Event:*
Will be displayed on District event calendar
Date(s) Requested:*

MonthDayYear
MonthDayYear
MonthDayYear
MonthDayYear
MonthDayYear
Facility Requested:*

High School ClassroomHigh School GymMiddle School ClassroomAux GymMiddle/High School CommonsElementary School GymMiddle/High School KitchenMain Street GymMiddle/High School CafeteriaAthletic Complex - All FacilitiesMiddle/High School IMCAthletic Complex - Football FieldMiddle/High School Conference RoomAthletic Complex - TrackElementary School ClassroomAthletic Complex - Pavilion/Concessions/RestroomsElementary School KitchenMemorial Park - All FacilitiesElementary School CafeteriaMemorial Park - Baseball FieldElementary School IMCMemorial Park - Flag Football FieldElementary School PlaygroundMemorial Park - Pavilion/Concessions/RestroomsDistrict Conference RoomMemorial Park - Skate ParkDistance Learning LabMemorial Park - Tennis CourtPoolHigh School Football Practice FieldFitness CenterHigh School Softball FieldAuditoriumElementary Softball/Baseball FieldOther
If needed, indicate specific classroom, "other" facility requested, etc:
Event Start Time:*
Event End Time:*
Event Description:*
Set Up Time:
If facility is needed before the event start time to set up.
Take Down Time:
If facility is needed after the event end time to take down and clean up.
Special Request/Set Up:*
Attendance Expected:*

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