ECASD Facility Use Request Form

ECASD Facility Use Request Form

Please complete the form below. Required fields marked * Requests by outside organizations are not guaranteed due to possible use by school organizations/activities/athletic teams. Please be aware that due to security purposes, weekend use of facilities by outside organizations will require a custodian to unlock and lock the facility. Weekday use of facilities should end by 9:00pm.

Contact Information

Person Responsible*

Email*

Your email

Name of Organization*

Select which best describes your organization*

Non-Profit 503(c)

For profit

Other

Applicant Phone Number*

Applicant phone number

Phone

Applicant Address*

Facility Request Information

Facility Requested*

Select

Additional Services

Select

Other Services Requested

Please be specific

Police / Security*

Police and/or Security are required for certain-sized crowds and events. The District will determine the number and type of security to be provided, and the applicant shall pay for security personnel at a rate of $45/hr on Saturday and $70/hr on Sunday per individual. This charge is in addition to rental fees.

I have read this and agree to the additional fees if security is required.

Event Information

Purpose for Request*

Please be specific

Requested Dates*

Date(s) desired (Saturday and Sunday requests require a custodial hourly fee - $40.00/hr on Saturdays, $60/hr on Sundays). No ECASD facility can be used before 1:00 PM on Sunday. This charge is in addition to rental fees.

Hours Requested*

Hours requested (include begin time and end time- please include set up and tear down time)

Alternative Date(s)*

Estimate Number Attending*

Percent of participants who are Ellwood City Area School District residents*

Will admission be charged?*

Yes

Admission Amount

Small Games Of Chance*

Will you be operating small games of chance?

Yes

Small Games of Chance license

If yes, please email a copy of your Small Games of Chance license. Requests will not be approved until the license is received.

Drag and drop files here or

Agreements and Acknowledgments

Policy 707 And Attachments

Policy 707

The Hold Harmless and Indemnification Agreement

License Agreement.

These forms will be mailed to you once the School Board has approved your request. These forms must be completed and returned to the District Office. Failure to return completed forms will null and void the facility request.

Policy 707 agreement*

I have read Policy 707 and all attachments and agree to the rental terms outlined in the Rental Statement.

Wave rental fee request*

Based on the District Guidelines, I request the board to waive rental fees (custodial and security fees cannot be waived)

Yes

Certificate of Insurance

Please email a copy of your Certificate of Insurance to Nancy Nocera at nnocera@ecasdk12.org

Send me a copy of my responses

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