Title: Microsoft Word - facilities use form
Author: rcarpenter
Company: Microsoft

REQUEST FOR RENTAL/USE OF FACILITIES APPLICATION 
Kentucky Xplosion
NAME OF REQUESTING ORGANIZATION 
HS Gym
AREA OF THE FACILITY 
Jeff Kramer, Head Coach	Sundays 2-4 p.m.    12/10-2/15/2010
PERSON SUPERVISING ACTIVITY 	DATE(S) REQUESTED TIME: (Please specify AM or PM ) 
THE REQUEST AREA(S) OF THE FACILITY WILL BE USED FOR THE FOLLOWING ACTIVITIES: 
Softball Practice  
Is the organization planning to conduct sales on school premises?Choose an item. SCHOOL EQUIPMENT TO BE USED: Pitching Machine APPROXIMATE #OF PERSONS: 10 players, 2-3 coaches 
	xxI request waiver of the rental fee. Please X if applicable 
	xxI request waiver of the charge for custodian.  Please X if applicable 

Fee Schedule The organization agrees to pay the applicable fee(s) for the use of District facilities 
Facility/Equipment Fee $Click here to enter text. Personnel Cost $ Click here to enter text. Insurance Cost $Click here to enter text. Total Cost $Click here to enter text. 
I have read the Rules and Regulations for Community Use of School Facilities and agree on behalf of the requesting organization to assume personal responsibility for the proper use of the above named areas of the 

facility.
Jeff Kramer/Bonnie Humphries SIGNATURE OF PERSON MAKING REQUEST ON BEHALF OF THE  ORGANIZATION | Click here to enter text. Address PHONE Home enter text. | Cell text.
DATE Click here to enter text. | |

In the event school is closed due to weather conditions, all scheduled activities, with the exception of dinner meetings, will be cancelled and opportunity to reschedule or refund rental fee(s) will be made. 
AREA BELOW FOR OFFICIAL USE ONLY 
Click here to enter text. 	 
MARTHA SEBRING for Café Requests 
Click here to enter text. 
JON JONES/LINDA EDMONDSON for Gym Requests 
Click here to enter text. 	 
KEITH HOWARD for Auditorium Requests 
Click here to enter text. 
PRINCIPAL 
_______________________________		______________________________
SUPERINTENDENT    			BOARD CHAIR DATE