Community Relations
Application to use School Facilities
The Blaine School District Board of Directors wishes
to encourage use of school facilities by the community as long as use is of
lawful purpose and does not interfere with the District’s educational programs,
the primary purpose for which the buildings and grounds are intended. Community use of facilities is subject to the
terms of District Policy and Procedures and the current schedule of user
fees. Funds may be charged for the use
of school facilities to ensure that funds intended for education of children
are not used for other purposes.
Permission to use a particular facility may be denied based on a belief
that the activity proposed is not in the District’s interests, or due to the
level of previously scheduled use. No
person shall be denied the full enjoyment of the facilities because of race,
creed, color, sex, or origin.
NAME OF
ORGANIZATION_________________________________________________DATE OF REQUEST________________
CONTACT
NAME__________________________________________NUMBER OF
TEAMS/PARTICIPANTS________________
ADDRESS_________________________________________________DAYTIME
PHONE_________________________________
NATURE AND PURPOSE OF ACTIVITY________________________________________________________________________
SPECIFIC FACILITY/SCHOOL
REQUESTED__________________________INSURANCE POLICY NUMBER______________
□ Classrooms □ PAC □ PAC Annex □ MS Cafeteria
□ MS Kitchen □ Elementary Kitchen
□ Primary Kitchen □ Primary Multi-Purpose □ Primary Library
□ Elementary Library □ KW Gym
□ Middle School Library □ High School Library □ Car Wash Parking Lot □ Middle School Gym
□ High School Gym □ Elementary Gym □ Tennis Courts
CAMPUS FIELDS: □ Baseball #1
□ Baseball #2 □ Soccer Fields
□ Primary Field □ Football Field
□ Track □ Football Practice Field
EXTRAS: □ Announcers Booth
□ PA □ Concessions □ Bleachers
□ Football Field Lights □ Locker Rooms
□ Mat Room □ Weight Room
□ Scoreboard □ Volleyball
□ Badminton □ Gymnastics Room
□ Track Lights
PIPELINE
FIELDS:
Soccer: □ Field #1 □ Field #2 □ Field #3 □ Upper Field
Softball: □ Field #1 □ Field #2 □ Field #3 □ Field #4 □ Batting Cage
Baseball: □ Field #1 □ Field #2 □ Batting Cage
DATES TO BE
USED________________________TO_______________________DAY OF
WEEK__________________________
TIMES OF DAY/EVENING:
FROM___________________________AM/PM
TO____________________________AM/PM
WILL ADMISSION BE
CHARGED?__________________WILL CUSTODIAL SERVICES BE NEEDED?___________________
(Custodial services are
restricted to unlocking and locking doors, operating lights, performing routine
cleanup.)
EQUIPMENT NEEDED: □ Chairs □ Tables □ Screen □ Microphone □ Other________________________________
FACILITY RENTAL FEES will be determined by the latest established rental
rates. Payment of charges shown on the
application form is to be made to the district within 30 days. Charges may be levied to cover the cost of
additional services not covered in the original agreement or for damages or
agreement violations. The District
reserves the right to require and charge for custodial and/or other authorized
District employees to be on the premises.
The person or organization entering into a rental
agreement with
In accordance with Chapter
28A.335 RCW, private nonprofit groups serving youth are required to provide
proof of bodily injury coverage of no less than $50,000 per occurrence/$100,000
aggregate. For-profit, business groups
are required to provide proof of general liability coverage of no less than $1
million dollars per occurrence.
The applicant agrees that the
school district and its agents or employees will not be liable for any damage
to person or property by reason of negligent acts of applicant, its agents,
employees, invitees, or subcontractors.
Applicant agrees to protect, indemnify for legal costs and other
expenses, and hold harmless, the School District and its officers, employees,
directors and agents from claims, liabilities, or suits, arising out of injury
to person or property from negligent acts of applicant, directly or indirectly
attributable to user’s activities and/or use of premises except for sole
negligence of the District.
I have read the rules and regulations above and on
the reverse side of this form and agree with the conditions and charges as
established. I have received a copy of
the Use of School Facilities Rules and Laws.
SIGNATURE OF
APPLICANT___________________________________________________DATE_________________________
RULES AND REGULATIONS
¨
Applicant/organization is responsible for the safety and conduct of its
participants and spectators.
¨
The applicant must provide satisfactory sponsorship and adequate adult supervision. Security may be required for some activities.
¨
All events will be required to meet the occupancy load and fire and
safety regulations of the City of
¨
Use of alcohol, tobacco, and/or drugs is prohibited. Profane language and/or other objectionable
conduct may result in barred use of facilities.
¨
Firearms or other dangerous weapons are prohibited on school grounds as
defined by law.
¨
Games of chance, lotteries, and giving of door prizes are not allowed
except where permitted by law and then only with proper clearances.
¨
Access to facilities and services, except as otherwise addressed in
these rules, shall be limited to that specified on the application.
¨
Alterations to the field/facility are prohibited without prior
approval. This may include such things
as hanging signs, erecting backstops, placing goals, using masking tape on
walls and floors, etc.
¨
District-owned equipment shall not be removed from the facility or
loaned to any individual or organization unless prior approval by the district
has been granted. Groups or individuals
cannot use district-owned expendable supplies.
¨
Applicants are responsible for special set-up requirements and clean up
unless specifically requested in the application. Users shall be responsible for returning the
facility to its original condition immediately following the event.
¨
Appropriate gym shoes are required for all activities on the uncovered
floor of gymnasiums.
¨
The applicant/organization shall not practice discrimination of any
kind.
¨
Cancellations by applicants require at least 24 hours notice. Otherwise, related actual costs shall be
borne by the applicant.
¨
Facility use is cancelled when facility/building is closed due to an emergency
or at the discretion of the District.
¨
The district reserves the right to refuse or revoke any authorization
issued for the use of a school building or grounds, and if rental has been
paid, to refund such rental less expense incurred by the district in connection
therewith.
FOR SCHOOL DISTRICT USE ONLY
□ Approved □ Disapproved Certificate of Insurance: □ Received □ Requested
Facility/Building Rental Fee
$____________________Per Hour/Event $____________________Other Charges $________________
Total Billed
$___________________________ Date
Billed ______________________________
Facility
Supervisor______________________________________________________Date_____________________________
Athletic
Director_________________________________________________________Date_____________________________
PAC
Director__________________________________________________________Date_____________________________