Auditorium Usage Page
You must contact Mr. Stilson to check for auditorium availability PRIOR to submitting a usage form.
Phone: (814)345-3911(from an outside line), ext.1151 (In School) or dstilson@westbranch.org
We reserve the right to deny any request if proper procedures are not followed.
Request for Auditorium Usage
Name of Organization:
Person Responsible For Arrangements:
Email address:
Work Number: Home Phone:
Today's Date: Requested Date of Use: (NOTE: No more than one month per form)
Time of Use: (beginning and ending): Event Start Time:
Reason for Use:
Will set up be needed for your event? --- YES NO If NO, Skip the table below.
Custodial
Flat Risers 0 1 2 3 4 5 6 7 8 9 10 11 12 13+
Choral Risers 0 1 2 3 4 5 6
Tables 0 1 2 3 4 5 6 7 8 9 10 11 12 13
Chairs (List #)
Podium NO YES
Sound
Wireless Mic 0 1 2 3 4
Lapel Mic 0 1 2 3 4 5 6 7 8 9 10 11 12 13
Wired Mic 0 1 2 3 4 5 6 7 8
CD/Tape Player NO YES
DVD/VHS Player NO YES
Monitors NO YES
Lighting
Stage Lights NO YES
Dimmed House Lights
(For Projected Presentations,etc.) NO YES
Spot Light NO YES
Technology-Other
Labtop NO YES
Projected Presentation NO YES
Projection Screen NO YES
Piano NO YES
Organ NO YES
Security Required: --- No Yes If yes, indicate the number of security required. Rental/Custodial fee to be paid: $
Other (Questions, Concerns or Addition Setup Not Listed Above)
We hereby agree to abide by all rules and regulations and make such payments as approved by the Board of School Directors governing the use of said facilities and equipment. We further agree to exercise discretion regarding the use of said facilities and equipment, to make all necessary arrangements for the services of approved personnel, to assume responsibility for damage of school property and equipment, to use only those facilities and areas as stated above, and to assume all responsibility for the actions and conduct of the participants. User holds the school district harmless from all claims for injury to or the death of any person and for damage to or loss of any property arising out of or attributed directly or indirectly to the operations or omissions of the school district. User idenmnifles the school district for all damage to property belonging to the school district and for all injuries to the deaths of any representatives or employees of the school district resulting from all acts or omissions or use. The school district is not responsible for user’s property. User must arrange all protective services desired by user. The school district is not liable for the acts or omissions of any protective services engaged by user. The school district may cancel any scheduled events on short notice for district use. (Games, repairs, etc.) PLEASE INCLUDE A COPY OF YOUR LIABILITY INSURANCE FOR YOUR ORGANIZATION.
You must read the above information
and check “I agree with the above statement” PRIOR to submitting this form.
I DO NOT AGREE WITH THE ABOVE STATEMENT I AGREE WITH THE ABOVE STATEMENT
Questions or concerns about this site?
Email: dstilson@westbranch.org
