To review WD Board Policy information on Use of Facilities and Equipment, click on the links below:
Is this a Student or Adult Group?
Is this Group Inside or Outside Western Dubuque School District boundaries?
|Please select all that apply to your group/team/organization:|
|Please select all that apply to the ACTIVITY for which you are requesting facility usage:|
Will concessions be sold? If yes, please contact Clif Cameron at 563-744-3885 ext. 6041 at least 2 weeks before event.
Has a Certificate of Liability or copy of your homeowner's insurance policy been provided to Building Principal? (Required for rate class III or IV.)
Event Details: Please provide a detailed description of what the event will entail
NOTICE: If shool is released early or cancelled, due to inclement weather, outside teams and groups will not be allowed to use school facilities at that time."
If recurring monthly event, specify which week of the month event will occur.
If recurring monthly event, specify which day of the week the event will occur.
Equipment Needed (i.e. tables, chairs, projector and screen, athletic equipment, show choir risers, choral risers, sound shell and clouds, etc.)
|It is hereby acknowledged that I have read the guidelines for use of school facilities and understand their content. I am authorized to sign this agreement on behalf of the organization named above. The Board of Education shall be held harmless for any damages to persons or property arising from the sponsored activity. The failure to abide by the above-mentioned terms or repeated wanton abuse of the facilities will result in cancellation of this and any future contracts. I agree to notify the building principal in the event of a cancellation or variation.|
|Auditorium Use Questions:|
|What time will the auditorium need to be open to the public or user group?:
Lighting Needs: Please check which best describes what you need for event
Sound Needs: How many microphones will you need?
|Will you need use of the kitchen?:
|Please indicate whether you need use of the Gym?:
|If using gym for basketball, indicate the height you want basketball rims set at:
BUILDING PRINCIPAL MUST COMPLETE ALL SECTIONS BELOW REGARDING FACILITY USE CHARGES PRIOR TO APPROVING (REFER TO BOARD POLICY LINKS ABOVE)
Rental Schedule Class
Is facility use billable or non-billable?