REQUEST FOR RENTAL/USE OF FACILITIES APPLICATION 
Dorman Products
NAME OF REQUESTING ORGANIZATION 
HS Café/Gym
AREA OF THE FACILITY 
Dan Hambrick 	September 15, 2012 
PERSON SUPERVISING ACTIVITY 	DATE(S) REQUESTED TIME: 10 am – 5 pm (Please specify AM or PM ) 
THE REQUEST AREA(S) OF THE FACILITY WILL BE USED FOR THE FOLLOWING ACTIVITIES: 
Company picnic – backup location only in case of rain
Is the organization planning to conduct sales on school premises?Choose an item. SCHOOL EQUIPMENT TO BE USED: Click here to enter text. APPROXIMATE #OF PERSONS: 200
	I request waiver of the rental fee. Please X if applicable 
	I 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 $Approx $150-200 for custodial services
	
Accepted by: Dan Hambrick, Dorman Products	859-283-4896
859-982-2700 cell		
DATE 9-5-12 			

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 
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MARTHA SEBRING for Café Requests              JON JONES/LINDA EDMONDSON for Gym Requests 
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PRINCIPAL 
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SUPERINTENDENT    DATE			BOARD CHAIR        DATE