Facility Use Application

School Building:

Application on Behalf of:

Event/Description of Activity:

Group Level RPS School Group (Level 1) PTO, Scouts, OM (Level 1) Non-Profit Org (Level 2) Community Based w/o non-profit (Level 3)

Date of Event

End Date of Event

Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Start Time am/pm

End Time am/pm

Requested Time for Set-up am/pm

Additional Dates

Number in Attendance

Area/Rooms Requested

Set up/Equipment needed (field lining, # of tables, # of chairs, microphone ect)

The undersigned is at least 21 years of age. He/She agrees to be responsible to the Board of Education for the use and care of school property and will be responsible for complete supervision of all parties participating in this activity. It is further agreed that the character of entertainment/meeting will conform with the rules governing the use of Rockford Public Schools. The applicant agrees to hold harmless the District and its agents and employees from and against all claims, damages, losses, and expenses including attorneys fees arising out of or resulting from applicant’s use of District facilities.

Date

Applicant Name

Signature

Email:

Phone

Email completed form to Jason VanderLaan at JVanderLaan@rockfordschools.org no later than 10 days prior to the date of the requested event

Facility Use Application

Facility Use Application

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