905.1E1 - Facility Request Form

Clarinda Community Schools
Facility Request Form

 

User's Name: _____________________________________    Date:__________________

Phone:________________      Email:___________________

Date Requested:_________________

Facility Requested:__________________   Food/Beverage Sales:  Yes    No

Doors Unlocked: ________ AM/PM     Until:__________ AM/PM

Special Needs:

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                                             (Below Info Filled Out by Administration)

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The reserving organization agrees to abide by the following instructions:

1. The area of the facility used will be cleaned by the User.
2. The use of tobacco or consumption of alcohol is prohibited on school property.  Food and beverages are not allowed in certain areas of the building.  All food and beverage sales shall be approved prior to signing the agreement.
3. Weapons of any sort are prohibited on school property.  
4. The School administration has the right to refuse or revoke the reservation of the building.

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Please see Policy 905.1R3 Fee Schedule

 

Rental Fee:________    +  Personnel Fee:______ = Total Fee_________

 

User Name_____________________ Address___________________ City_________ State _____ Zip________ Phone__________________ Date_______   Signature___________________________

Administration Name: Jake Lord Position: Activities Director School Phone: 712-542-5167 Email: jlord@clarindacsd.org Date_______ Signature___________________________