WEST BRANCH AREA SCHOOL DISTRICT

.Name of Organization: 

Person Responsible for arrangements: 

Email address:   

Work Number:       Home Phone: 

Today's Date:      Requested Date of Use:    Time of use: (beginning and ending): 

Reason for use: 

(NOTE: No more than one month per form if the request is for several months.)

 Set up by technology, custodial, and/or audio/video (if needed):

Security Required:  Yes  No     If yes, please indicate the number of security required. 

Rental/Custodial fee to be paid:  $

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 the 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.

I agree