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1330
Form 1
COLCHESTER PUBLIC SCHOOLS
Application for Use of School Facilities
Facility requested _________________________________________________________________
Name of Organization ______________________________________Date ___________________
Organization Contact Person___________________________Telephone # ___________________
Email___________________________
Address ___________________________________________ Business # ____________________
Name of Organization Site Supervisor______________________________Home # ____________
Requesting Use of (Check area(s) Requested):
Shower Facilities Lavatories
Cafeteria/Multi-Purpose Room Kitchen
Auditorium Media Center/Library
Classroom(s) (Specify) Parking Lot
Other (Specify)
Equipment Requested______________________________________________________________
Additional Setup Requested ________________________________________________________
Nature of Activity_________________________________________________________________
Date(s) Requested _____/_____/______________From ______A.M./P.M., TO ______A.M./P.M.
Month Day Year / Day of Week
_____/_____/______________From ______A.M./P.M., TO ______A.M./P.M.
Month Day Year / Day of Week
(Each event, for each calendar day must be provided. Include rehearsal dates. Use the
attached (1A) of this form for additional dates.)
Number of People to Attend (estimate) _______________ Likely Minimum __________________
The using group or individual assumes all responsibility for damage, injury, and other liabilities. The using group
making application will use the facility in accordance with the Colchester Board of Education Policy, Regulations and
Bylaws. The applicant shall take notice that priority for the usage of the facilities, including conflicts in scheduling and
rescheduling for unforeseen circumstances, shall be: 1) School activities, 2) Scheduled community events, NON usage of
the facility by the applicant for three (3) scheduled events shall lose all rights of usage in the future.
Signature of applicant____________________________________________________Date: _____________________
Building Principal _______________________________ Date: ____________________
Further Action by:
Request is granted
Request is denied Superintendent of Schools ________________________ Date: _____________________
1330
Form 1
continued
Requests for additional equipment, special setups, security, or other agreements between the
School Principal and the Applicant. Example: Storage of applicant’s personal property, whether
food and beverages are being provided during the event.
Signature of School Principal _________________________________ Date ________________
The undersigned agrees to repair or replace any equipment, structure or physical components of
the buildings or facilities which are damaged or lost pursuant to the applicants use of the school’s
buildings, facilities, or equipment. Furthermore, the undersigned agrees to any special setups,
additional security or to any request by the School Principal. Changes to the activity or other
requests shall be in writing on this form. Non-compliance with the Board of Education’s
policies, regulations and/or with agreements contained in this application shall be cause for
immediate revocation of the permit. This applicant shall cease and desist all activities once
directed to do so by the school staff members and shall immediately vacate the premises. If no
agreement and action to rectify, the hazard is forthcoming.
Signature of Applicant _____________________________________ Date _________________
Required attachments:
1. Certificate of Liability/Property Damage Insurance in the amount of $1,000,000.00,
naming “Town of Colchester” and “Colchester Public Schools” as an additional insured.
2. Rental charges payable to “Town of Colchester.”
3. Letter setting out applicant organization’s non-profit status.
Revised 9/2019