BEVERLY CITY BOARD OF EDUCATION

APPLICATION FOR USE OF SCHOOL FACILITIES

Name of Organization:

Purpose of Use:

Dates of Usage:

Equipment/Items brought to premises:

Day(s) of the week requested: Monday Tuesday Wednesday Thursday Friday

Time Requested - From: ______:______a.m. p.m. to: ______:______ a.m. p.m.

Day(s) of the weekend requested: Saturday Sunday

Time Requested - From: ______:______ a.m. p.m. to: ______:______ a.m. p.m.

Area Requested: Gym Cafeteria Classroom (Room #_______)

Use of Equipment: Chairs #____ Tables #____ Microphone Sound System

Other:

Estimated number in attendance: ________

Name of adults to be present and in charge: (This information may be given to individuals who may call for information about your event.)

Name: __________________________________	Name: __________________________________

Contact phone number: (______) ______-______	Contact phone number: (______) ______-______

Email: __________________________________	Email: __________________________________

REGULATIONS/INSURANCE COVERAGE: Applicants agree to abide by the Rules and Regulations governing the use of school facilities as promulgated by the Board of Education of the Beverly City School. All applicants shall indemnify and hold harmless the Board of Education, its agents and/or employees from and against any and all claims, damages, actions, liability and expenses including reasonable attorney fees and court costs in connection with a loss of life, personal injury and/or damage to the property arising from or out of life, personal injury and/or damage to the property arising from or out of the occupancy use or the performance by the applicant, and/or applicant’s employees, agents, members or invitees, as well as any participants in the activity sponsored by the applicant occasioned wholly or in part by any act or omission of the applicant, its employees, agents, members, invitees and/or participants in its activities. The applicant has inspected the area in which its activities will be conducted and acknowledge hereby that such area is safe and suitable for the activity contemplated by the applicant. The Board of Education reserves the right to refuse, to cancel or postpone any request for use of school facilities if conditions warrant such actions. If you will not be using the facilities as requested, please notify the Board of Education by calling 609-387-2200, 48 hours in advance, otherwise applicable fees will be charged. All fees are to be paid in full to the Beverly City Board of Education upon receipt of invoices. You will be advised if advanced deposits are required. The above stated organization maintains a current insurance policy that insures or covers all participants, spectators or other persons in attendance: also covers any damage to facilities that occur while the organization is present. Minimum amount of coverage required shall be $1,000,000 combined single limit bodily injury and property damage. The Beverly Board of Education shall be named as an additional insured. A certificate of insurance which includes (30) thirty day cancellation clause must be submitted prior to the scheduled event.

SUBMITTED BY:

Name of Organization:

Date: ____________________

Printed Name:________________________________

Signature:

Address to mail approval notification:

Contact phone number: (______) ______-______ E-mail:

Business Administrator: ___________________________________ Date: