KG-R2 - Application for Use of School Facilities
ACTON SCHOOL DEPARTMENT
Application for Use of School Facilities
Please complete this form as thoroughly as possible and return to the school office. The Acton School Committee encourages community groups to use school facilities for civic, educational, cultural or recreational purposes. It is intended that the facilities (including the gymnasium, cafeteria, designated classrooms, and playing fields) be available for controlled use by the public according to a schedule of charges according to type of use. Priority of use shall always be given to school related activities first, town related activities second and other activities third. School activities will always take precedence over any other use of school facilities, even ones that were scheduled. The school secretary will call you if there is a scheduling conflict.
Name of Group/Organization: _________________________________________________
Date (s) Requested: ____________________________ to __________________________
Day (s) of the Week if Recurring: ______________________________________________
Start Time: _______________________ End Time: ________________________________
Description of Activity:
_________________________________________________________________________
_________________________________________________________________________
Number of people in group: _____________ Ages of people in group: ______________
Room(s) Requested:
☐ Classroom: _______ ☐ Cafeteria
☐ Kitchen ☐ Gym
☐ Athletic Field ☐ Other: __________________________________
Setup requirements: _______________________________________________________
Equipment needs: _________________________________________________________
(please fill out back side of this form→ )
Supervising adult directly responsible for activity:
Name: ________________________________________________________________________
Phone: ____________________________ Work Phone: __________________________
Email address: ____________________________________________________________
The Acton school does not accept responsibility for any injuries or damages caused by the use of any of its facilities, and the user is responsible for any injuries sustained or damages caused by said user(s). Persons using the facilities are NOT allowed to use any supplies, equipment, or other Acton School property (even if closets are unlocked they are off limits to non-AES staff). This request is for the use of the space ONLY. If any equipment is damaged or missing, I agree to replace it at full value immediately. I have also read the school policy on Community Use of Facilities. (a copy is available on the website or from the School Secretary for review)
Signature__________________________________________ Date: __________________
----------------------------------------------Office use only-------------------------------------------------
The above application is:
☐ Approved ☐ Denied ☐ Fee Required Amount: $_________
(fees to be paid 2 days prior to use)
Approved by: _____________________________________ Date: ________________
Superintendent/Principal
Cross Reference: KG – Community Use of School Facilities
KG-R - Community Use of School Facilities Procedure
Updated: March 10, 2017
Reviewed: June 13, 2017