Facility Use with Food 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 (if recurring)

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

Email:

Phone

Food Services

If your event will have food served, please check all boxes that apply:

Food is being catered through Rockford Food Services

Food is being catered by an outside business and being prepared off-site. Food is brought in ready to serve.

If yes, provide the name of business catering:

Is Your Food Being Catered? Yes No

If yes, provide the name of business catering: Food Services Director approval is required (if approved, staff charges will apply) Approval/Signature of John Henry, Food Service Director:

Food is being sold by a Mobile Food Vendor. NOTE: RPS cannot provide electric or water hook-up for mobile vendors.

If yes, provide the name of each vendor, along with description of food sold:

Attach copy of Michigan Mobile Food License Attach copy of insurance certificates naming RPS as an additional insured.

Filename Size Status

0 b 0%

Signature

Submit completed form no later than 10 days prior to the date of the requested event

Facility Use with Food Application

Facility Use Request

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