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Coachella Valley Unified School District
Use of School Facilities Application Rev. 3.28.22 Form
7/5/2022

83-733 Ave. 55, P.O. Box 847, Thermal, CA  92274
(760) 398-5909 Ext. 200
USE OF SCHOOL FACILITIES APPLICATION

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The undersigned hereby applies for use of school property for public purposes in accordance with Board Policy Number 1330, inclusive of Policies, Rules and Regulations of Governing Board.
BP 1330
Click to download Board Policy 1330
*
GROUP/ORGANIZATION
*
PERSON IN CHARGE
*
ADDRESS
*()- Ext.
PHONE

Billing information required

*
NAME
*
BILLING ADDRESS
*
CITY, STATE, ZIP
*()- Ext.
PHONE

E-MAIL ADDRESS

PLEASE DESCRIBE THE EXACT NATURE AND PURPOSE OF YOUR GROUP

Non-Profit?: *
Yes  No  
Facilities Fee Chart
Click to download Fee Chart
Description: *

DESCRIPTION OF PROGRAM OF ACTIVITY:

Activity Description: *
Is activity open to the public?: *
Yes  No  
Will admission fees be charged?: *
Yes  No  
Will contributions or other fees be solicited at the meeting?: *
Yes  No  
.

If charge is made or contributions are solicited, please describe the purpose for which money will be used:

*
Facilities Requested
School:
Facility:
Date:
Start:
TIME
End:
TIME

If you are requesting more than one day, please complete the following:

Recurrence Pattern:
Daily  Weekly  Monthly  
Sun  Mon  Tue  Wed  Thu  
Fri  Sat  
Range of Recurrence
Start:
Date
End:
Date
Beginning:
Time
Ending:
Time
End after:
number of occurrences

OR

End by:
DATE
TOTAL NUMBER OF DAYS:
COMMENTS:
Attachment(s) - Certificate of Liability: * Click to Upload Files

INSURANCE REQUIREMENT

Please attach Certificate of Liability or other insurance for the protection of the public and the District, as the District may require, and also submit an insurance declaration or endorsement identifying the Coachella Valley Unified School as an ADDITIONAL INSURED IN THE MINIMUM AMOUNT OF $500,000 Personal Liability (each occurence).

STATEMENT OF APPLICANT

Applicant hereby agrees to hold the Coachella Valley Unified School District, its Board of Trustees, the individual members thereof, and all District Officers, Agents, and Employees free and harmless from any loss, damage, liability, cost or expense that may arise during or be caused in any way by such use or occupancy of school property.  I hereby certify that I will be personally responsible on behalf of the applicant for payment of all charges assessed for the use of the above premises and for any damages sustained by the school building, furniture, equipment, and or grounds accruing through the occupancy or use of said building and/or grounds by the applicant. 

I, the requestor, hereby certify that I have read and agree to abide by the rules and regulations accompanying this application, as set forth in the policies of the board of Trustees and according to the laws of the State of California.  NOTE:  The person submitting this application and the statement above must be a member of the sponsoring organization.  If the requestor is not an officer of the organization for whom the application is made, written authorization must be submitted from the applicant group to sign the foregoing application.

Rules & Regulations
Click to download Rules & Regulations
CERTIFICATION: *
I, the named requestor, agree to the terms and conditions stipulated in this request.  
*
DATE
*
REQUESTOR

TITLE
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EQUIPMENT REQUIRED

Please check equipment needed. (Equipment will NOT be provided unless it has been requested and approved in advance.)

Chairs  
How many?:
Tables  
How many?:
Microphones  
How many?:
Other  

Special Instructions, Arrangement of furniture, etc.


OFFICE USE - DO NOT WRITE BELOW THIS LINE

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CUSTODIAL

Hours:
Per Hour $:
TOTAL $:

TECHNICAL

Hours:
Per Hour $:
TOTAL $:

SECURITY

Hours:
Per Hour $:
TOTAL $:

OTHER LABOR

Hours:
Per Hour $:
TOTAL $:
Utilities $:
Rental $:
Other Fees $:
TOTAL FEES DUE:
Is Security Required:
Yes  No  
Certificate of Insurance has been submitted:
Yes  No  
COMMENTS:
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Your E-mail:*
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Your Routing Level: General
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