Middle High School Request – West Branch Area School District

All Requests Must be Submitted 15 Days Prior to Use/Activity:* PLEASE CHECK CLASS Class A: N/A Class B: $1,000,000 Class C: $1,000,000 Class D: $1,000,000

Class A: School Organizations, Clubs, PTO, Booster Clubs, Band Parents, Alumni, Etc.
Class B: Non-fund raising activity, Little League, Boy/Girl Scouts, Civic Group, Etc. $1,000,000
Class C: Civic or community group that involves fund raising and pays rental fee. $1,000,000
Class D: Any outside organization which meets Board Policy and pays rental fee. $1,000,000

Any civic or community group or organization offering to present a program, instructive and beneficial to the participants that involves fund raising and/or an admission fee.

Yes
No

Name of Organization *

Person responsible for arrangements: *

First

Last

Email Address *

What date are you requesting the building: *

Start Time *

End Time *

What area(s) of the building are you requesting? *

Additional Items requested

What type of activity will take place? (Dance, Mtg, Banquet, etc)(*) You must list the designated representative of your group that will be present at the activity and responsible for the supervision. *

Set up by technology, custodial, and or cafeteria staff (if needed) *

Yes
No

List Material(s) and/or Equipment Required

Signature- Organization representative: By my signature I represent that I am authorized by the organization to enter into this agreement and that I have read and understand the “Use of School Facilities and Equipment Policy and Guidelines” as set forth in Policy No. 707 and agree to all terms and conditions of these regulations. *