AR 830 (Exhibit) Application for Use of School Facilities



    School Building Requested:                                                                                                             


    Room/Facility(s) Requested:                                                                                                           


    Person Requesting Use of Facilities:                                                                                               






                Organization Affiliation:                                                                                                      


    Purpose for which facilities are being requested:                                                                           




    Date of Event:                              Starting Time:                             Ending Time                           


    Date of Event:                              Starting Time:                             Ending Time                           


    Date of Event:                              Starting Time:                             Ending Time                           

    Use back of page if additional dates are required)


    Those requesting facility usage must read and agree to the following terms:


    1.   I have received a copy, read, and understand all provisions of the School District of Fort Atkinson Administrative Rule 830 (AR 830).


    2.   On behalf of the organization using the facilities, I am agreeing to abide by these regulations and will be responsible for the preservation of order and care of the protection of the building and equipment. 

          I further acknowledge that charges for any damages are my responsibility as well as the responsibility of the organization I represent.


    3.   I understand that charges for the use of the building and equipment will be assessed by the building principal or their designee according to policy and I agree to pay these charges as stipulated in

          AR 830.


    4.   I stipulate that insurance provisions (circle one:   are,    are not ) needed.




                             Signature of Applicant                                                                Date



                                 Responsible Party                                                                   Date

    Application Determination (to be completed by building principal or designee):


    Application for Facility Use (circle one)         Accepted         Rejected


    Fee Group (circle one)            Group 1           Group 2          


    Amount to be Paid by Group:

    (refer to AR830 for Facility Use Fee Structure and related rules,

    plus applicable deposits)





    Signature of Building Principal/Designee                                   Date