Application for Use of School Facilities

Name of Organization making request*

Brief Description of Activity*

Name of adult who will assume responsibility*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Home Number*

Area CodePhone Number

Cell Number*

Area CodePhone Number

Business Number

Area CodePhone Number

Application is hereby made for use of what school or facility?*

Please check facilities requested (check all that apply):*

Beginning on - Day of the Week*

Beginning on - Date & Time*

MonthDayYearHourMinutesAM/PM Option

Ending on - Day of the Week*

Ending on - Date & Time*

MonthDayYearHourMinutesAM/PM Option

Is this a recurring event request?*

NoYes -- Daily (note details below)Yes -- Weekly (note details below)Yes -- Monthly (note details below)

Please click "yes" if additional usage is needed*

YesNo

More usage? Beginning on - Day of the Week (OPTIONAL)

More usage? Beginning on - Date & Time (OPTIONAL)

MonthDayYearHourMinutesAM/PM Option

More usage? Ending on - Day of the Week (OPTIONAL)

More usage? Ending on - Date & Time (OPTIONAL)

MonthDayYearHourMinutesAM/PM Option

Is this a recurring event request?*

NoYes -- Daily (note details below)Yes -- Weekly (note details below)Yes -- Monthly (note details below)

More usage needed? Click "Yes" if so.

YesNo

More usage? Beginning on - Day of the Week (OPTIONAL)

More usage? Beginning on - Date & Time (OPTIONAL)

MonthDayYearHourMinutesAM/PM Option

More usage? Ending on - Day of the Week (OPTIONAL)

More usage? Ending on - Date & Time (OPTIONAL)

MonthDayYearHourMinutesAM/PM Option

Is this a recurring event request?*

NoYes -- Daily (note details below)Yes -- Weekly (note details below)Yes -- Monthly (note details below)

Number of Participants*

Estimate the Number of Spectators*

Admission to be charged (if any)*

Special services or equipment needed:

Read Rules & Regulations/Waiver of Claims*

Yes

It is agreed that the Winton Woods City Schools property will not be used for any unlawful purpose and the Renter will keep the property in as good condition as it now is, reasonable use accepted.

It is further agreed that school use of the properties shall have first priority and that the Board of Education reserves the right to cancel this agreement if such need arises or if said agreement is found to be in violation of State or Local regulations.

It is expressly agreed that all use of the Winton Woods City School District facilities shall be undertaken by me at my sole risk, and I will indemnify, save, hold harmless and defend the Winton Woods City School District and its employees, and said school district and its employees shall not be liable for any injuries, damages or losses to me or my quests, or be subject to any claim, demand, injury, or damages whatever including, without any limitation, those damages resulting from acts of active or passive negligence on the part of Winton Woods City Schools or its employees, officers or agents. I, for myself, and on behalf of my executors, administrators, and assigns, do hereby expressly forever release and discharge Winton Woods City Schools, its successors and assigns, as well as its employees, officers, and agents for all such claims, demands, injuries, damages, actions or causes of action.

It is specifically agreed that the Winton Woods City Schools shall not be responsible or liable to me or my guest(s) for articles lost or stolen at the school, including their automobiles and contents therein.

Payment for use of District Facility is to be made within thirty (30) days after receipt of invoice. Make check payable to Winton Woods City Schools and mail to the Business Office at 825 Waycross Road, Suite A, Cincinnati, OH 45240.

I have read the rules and regulations governing the use of these facilities and hereby agree to abide by same. I also agree to pay for any damage which may result from said scheduled use. I understand that if this request is granted, it may be cancelled if, at any time, it interferes with school activity, or if, in the judgement of the superintendent, it is deemed to not be in the best interest of the school system.*

Yes -- I agreeNo

Signature -- please sign electronically with your mouse*

FOR OFFICE USE ONLY ... Principal approval

FOR OFFICE USE ONLY ... Business Office approval

FOR OFFICE USE ONLY ... Flat charge for Activity

FOR OFFICE USE ONLY ... Custodian charge (x hours at a rate of y dollars per hour)

FOR OFFICE USE ONLY ... Security personnel pass-through charge (x hours at a rate of y dollars per hour for N officers needed)

FOR OFFICE USE ONLY ... Supervisor charge (kitchens and/or HS Auditorium and/or Contest Management Fee for HS Stadium rental)

FOR OFFICE USE ONLY ... Room charge

FOR OFFICE USE ONLY ... Gym

FOR OFFICE USE ONLY ... Auditorium

FOR OFFICE USE ONLY ... Cafeteria

FOR OFFICE USE ONLY ... Estimated Total

WINTON WOODS CITY SCHOOL DISTRICT

Contact Information

Premises Requested

Recurrance

Additional Usage Requested?

Event Details

Acknowledgements

FOR OFFICE USE ONLY

Business Office - 825 Waycross Road, Suite A, Cincinnati, OH 45240 513.619.2400