Please submit request no later than 10 business days prior to first date

1Location Requested
2Preferred Alternate Site
3Type of Facility Preferred
ClassroomGymnasiumConference RoomMedia CenterKitchenCafe/CommonsHallway AreaFieldOther
4If you selected 'Field' or 'Other', please indiciate type of field, or describe your needed space.
5Indicated Day(s) needed
SundayMondayTuesdayWednesdayThursdayFridaySaturday
6Requested Dates
7Setup Time (include a.m. or p.m.)
8Event Start Time (include a.m. or p.m.)
9Event End Time (include a.m. or p.m.)
10Exiting Facility Time (include a.m. or p.m.)
11Activity Planned (be specific)
12Title of Event
13Name of Individual Requesting Facility
14Sponsoring Group
15

Equipment/Items group will bring in (Note: food/beverages restricted in some areas)

16Specific Room Setup Details (Note: Group responsible for own setup)
17Equipment/Needs From School District
18Estimated Attendance Ages 0-5
19Estimated Attendance Ages 6-18
20Estimated Attendance Ages 19-54
21Estimated Attendance ages 55+
22Estimated Total Attendance
23Person in charge and present during event
Responsibility Agreement
The applicant is considered responsible for the event.  The specific person on site in charge of the activity, if different than the applicant should be stated above.  The person designated as in charge during the usage time represents the applicant and the organization.  By entering your name below, which acts as your signature, you certify that you are an agent of the above organization and are authorized to accept, in their name, the responsibility for observance of the rules and regulations of ISD #728 pertaining to the use of the buildings and grounds.
24Name
25Address
26City
27Zip Code
28Email Address
29Work Phone
30Home Phone
31Fax
32Enter your name to act as your signature
Notice
After processing, a permit confirming your use will be sent to you.  YOUR EVENT HAS NOT BEEN SCHEDULED AND FACILITY USE HAS NOT BEEN AUTHORIZED UNTIL YOU RECEIVE THE PERMIT.  You must bring the permit with you to the event.