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Facilities Use Request

Please complete the form below. Required fields marked with an asterisk *

School/Facility/Property Requested *

Answer required for "School/Facility/Property Requested "

Date of Request*

Answer required for "Date of Request"

Use to be made of school/facility/property*

Answer required for "Use to be made of school/facility/property"

Contact Information of Person Resonsible

First Name*

Answer required for "First Name"

Middle Name

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Email 1*

Answer required for "Email 1"

Email 2

Answer required for "Email 2"

Mobile Phone*

Number Required

Home Phone

Number Required

Work Phone

Number Required

Address of Person Responsible

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Room or Facility Desired*

Answer required for "Room or Facility Desired"

Dates Needed*

Answer required for "Dates Needed"

Times Needed*

Answer required for "Times Needed"

Services and/or Supplies Requested*

Answer required for "Services and/or Supplies Requested"

Use to be made of room/space*

Answer required for "Use to be made of room/space"

Proof of Insurance

Answer required for "Proof of Insurance"

Choose a file or drag it here.

Statement of Information

The undersigned states that, to the best of the individual's knowledge, the school property for the use of which application is hereby made will be used for the commission of any act which is prohibited by law, or for the commission of any crime, including Penal Code or Education Code. The individual certifies (or declares) under pentaly of perjury that the foregoing is true and correct.

The individual also attest that they have read the entirety of the agree to the conditions required for the use of the facility.

Signature*

Signature Required

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"