PASCO SCHOOL DISTRICT NO.1

Transcription

1 54537 PASCO SCHOOL DISTRICT NO.1 FACILITY USE FORM NAME OF ORGANIZATION LAST NAME OF PERSON RESPONSIBLE FOR RENTING FIRST NAME PHONE ALTERNATE PHONE ADDRESS BILLING ADDRESS PURPOSE FEIN STREET CITY, STATE ZIP SALES TAX EXEMPTION NO. INVOICE TYPE? CHARGE BACK PAYMENT NO PAYMENT DOCUMENT NUMBER e.g. contract or permit number Is this activity open to the public? Yes No Is there a charge to participate? Yes No SCHOOL LOCATION PO NUMBER If yes, price to the public? If yes, price to participate? $ $ Angelou Chess Emerson Frost Livingston Longfellow Markham McGee Robinson Twain Whittier McLoughlin Ochoa Stevens EVENT TITLE Pasco High Chiawana New Horizon Capt. Gray Booth TYPE OF FACILITY Gym Classroom Kitchen Cafeteria Stadium F/B Field Stadium Soccer Stadium Track Stadium Night Use Other EQUIPMENT REQUESTS EQUIPMENT MAY BE MADE AVAILABLE ON A FIRST COME FIRST SERVED BASIS. SEE FEE SCHEDULE FOR CHARGES. TYPE OF EQUIPMENT NEEDED COST: SERVICE REQUIRED Electrician Custodial Audio Visual Cafeteria *Minimum 2 hour charge EVENT DATE START TIME AM PM SETUP TIME AM PM END TIME AM PM BREAKDOWN TIME AM PM Page 1

2 54537 PASCO SCHOOL DISTRICT NO.1 FACILITY USE FORM INSURANCE INFORMATION COMPANY COMPANY POLICY NUMBER COVERAGE COVERAGE DATES TO NUMBER OF PEOPLE ATTENDING NUMBER OF ADULTS NUMBER OF CHILDREN SETUP REQUIREMENTS SERVICE DESCRIPTION Audio/Visual Bleachers Concession Stand Custodial Electrical Event Breakdown Event Setup Food Services Grounds Gym Equipment Heating/Air Irrigation Lighting Lunch Tables Music Equipment PA System Performance Lights and Sounds Performance Mgmt. Playground Ramps/Platforms Scoreboards Screens Stage Setup Translator (what language) OTHER NEEDS SIGNATURE PRINCIPAL'S SIGNATURE DATE DATE PAGE 2

3 54537 APPROVAL OF AN APPLICATION FOR USE OF PASCO SCHOOL DISTRICT FACILITIES IS SUBJECT TO THE FOLLOWING REGULATIONS: 1. Any group or individuals using the facilities accept responsibility for damage done to District property and shall reimburse the District for such damage. 2. Approval will not be granted for any activity, which may be in any way prejudicial to the best interests of the schools. The group or individuals using the facilities must provide satisfactory sponsorship and adequate supervision. This shall include proper police and fire protection where necessary. 3. The user agrees to protect, indemnify, and hold harmless the District, its elected and appointed officials, employees, agents and staff from any and all claims, liabilities, damages, expenses, or rights of action, directly or indirectly attributable to the user s activities and/or use of premises in connection with this agreement. 4. The requirement to provide insurance and the amount of the insurance required shall be applied at the discretion of the District administration and shall relate to the nature of the scheduled event or activity. 5. When no service charge is made, the user agrees to clean the facilities and restore the equipment/furniture to its original arrangement. The district reserves the right to charge the user for cleaning or damage costs associated with returning facilities to their original state. 6. The building principal or his/her designee may require the presence of a custodian or other staff member to be on the premises when a non-school group is using a district facility. 7. Standard approved gym shoes are required for all activity-type usage in the District s gyms. Proper attire shall be worn at all times. 8. Use of the District facilities, equipment and services shall be restricted to those spaces and times specifically set forth in the Application and Permit for Use of School District Facilities. 9. Smoking is not permitted on District premises. Groups or individuals using school facilities accept responsibility for enforcement of this rule. 10. The transacting of business, merchandising, advertising or the signing of contracts, other than those, which occur in the normal business of the District or affect the students and employees of the District, are not allowed on District property except by special contract arrangement. 11. Advertising material of any kind shall not be distributed in the school buildings or on school premises without prior approval of the District. 12. Games of chance, lotteries, raffles, etc., are not allowed on District property with the exception of certain fund raising events of the District parent-teacher organizations or student organizations. 13. Boisterous conduct, profane language, possession or use of intoxicating liquor and or drugs shall not be permitted on District premises. 14. Users agree to abide by the laws of the State of Washington and the County of Franklin and by the regulations of the Pasco School District. 15. Fire and safety regulations of the District, Franklin County and the State of Washington shall be observed at all times. 16. The District reserves the right to cancel, upon short notice, any meeting or activity in any District facility. 17. The properly executed Application and Permit for Use of School District Facilities is the complete and exclusive statement of the agreement between the parties relevant to the purpose described therein and supercedes all prior agreement or proposals, oral or written and all other communications between parties related to the subject matter of the agreement. No modification of the agreement will be binding on either party except as a written addendum signed by an authorized agent of both parties. Ga-1 (Rev. 5/07)

4 PASCO SCHOOL DISTRICT NO. 1 Facility Rental Rates I II III Classification and Description School Related or Community Groups: PTA, PTO, school boosters, scouts, 4-H, recreation groups, service clubs, government groups, Kiwanis, school/community bands. Non-Community and/or Non-Profit Groups: Non-student lead youth groups: cultural organizations, adult recreation groups, political organizations, community colleges, vocation training. (Non-profit status documentation required.) Commercial Enterprises: Commercial businesses, for profit enterprises, recreational studios. Gymnasium Cafeteria Mall Kitchen (District staff required) Library Auditorium (District staff required) Booth Meeting Area Elem MS HS MS HS All All All All NO FEES WILL BE CHARGED - Provided that additional staff are not employed to supervise or clean the facilities. The district shall charge a rental rate in excess of costs incurred, except that such excess charges may be waived when a service club or other non profit group is raising funds for charitable purposes. $25.00 $25.00 $35.00 $25.00 $35.00 $20.00 $20.00 $50.00 $25.00 While the district prefers organizations to use commercial or private facilities, facilities may be rented at the prevailing rate charged by commercial facilities in the area. $ $ $ $50.00 $ $35.00 $30.00 $70.00 $50.00 Equipment Fees: Cost Additional Fees Cost Chairs (more than 25) $.12 ea Minimum 2 hour Charge Add'l Hour Tables (more than 2) $1.20 ea Custodian $80.00 $40.00 Music Stands (more than 15) $.30 ea Electrician $90.00 $45.00 Upright Piano no charge Audio/Visual $90.00 $45.00 Grand Piano $41.00 Plumber $90.00 $45.00 Overhead Projector $6.00 Cook $ Television $30.00 Stage Manager $90.00 $45.00 Television/VCR-DVD $42.00 Stadium Event Manager $80.00 $40.00 Platform Risers $13.00 ea Choral Risers $13.00 ea Spotlight $24.00 Piano Tuning (only at your request) $ Additional microphones/monitors $12.00 April 13, 2010 Detailed lighting set up $ P

5 Pasco School District No. 1 Fee Schedule In addition to the rent charged for facilities use, staff members may be asked to provide assistance. Added charges to compensate Pasco employees for their time should be calculated according to the following schedule. Cust. Elec. A/V Plumber Minimum 2 Hour Charge Pasco School District No. 1 Schedule of Additional Fees Cook Charge for Each Additional Hour Stadium Stadium Stage Stage Event Stage Stage Event Mgr. Crew Mgr. Cust. Elec. A/V Plumber Cook Mgr. Crew Mgr. Gym (Elementary) Gym (Middle School) Gym (High School) Kitchen (Elementary) Kitchen (Middle School) Kitchen (High School) Cafeteria (Elementary) Cafeteria (Middle School) Cafeteria (High School) Auditorium Stadium Stadium Lights /13/2010

6 Pasco School District No. 1 Pasco High School Auditorium Request for Auditorium Use Chiawana High School Auditorium Name of Organization Name of representative making application Person in charge of activity Load In & Setup Date: Time: Phone # Billing address: Performance - Arrive Open to Public time: Ends Load Out Certified Non-Profit Group Load In & Setup/Unload $12.00 per hour (2 hours minimum: not to exceed 4 hours) Rehearsal Days: Business or Profit Making Group $12.00 per hour Rehearsal Rate $18.00 per hour $30.00 per hour Administrative Fee (First hour of each performance) $60.00 $60.00 Hourly Rental Rate $50.00 per hour $70.00 Back Stage Dressing Rooms No Charge No Charge Band Room/Choral Room $36.00 per room per performance $60.00 per room/per performance Equipment subject to availability and prior reservation Auditorium's standard setup (equipment normally found in auditorium ready for use) Sound System: House speaker system, back stage & lobby monitor system, 1 to 4 microphones, 2 on stage, monitor speaker for performers, cassette deck &/or CD player, 16 channel mixing console Lighting system: Lighting control board, general stage area to be lit Other Equipment: Hearing assist receivers, 1 to 25 chairs, 2 tables, projection screen Additional Charges: Chairs (more than 25) $0.12 each Stage Manager will consider requested needs and will use and set Tables (more than 2) $1.20 each equipment as necessary. Stage Manager may also direct staff to set Music Stands (more than 15) $0.30 each and run equipment as necessary. Upright Piano no charge Grand Piano $41.00 Personnel (2 hr. minimum) Overhead Projector $6.00 Stage Manager $45.00 per hour Television/VCR-DVD $30.00/$42.00 Technician $45.00 per hour Platform Risers $13.00 each Custodian $40.00 per hour Choral Risers $13.00 each Lights $15.00 Spotlight $24.00 Sound $15.00 Piano Tuning (only at your request) $ Stage Crew $35.00 per hour Additional microphones/monitors $12.00 Recommend Stage Contract $ per hour minimum 2 hrs Detailed lighting setup $18.00 for auditorium performance, stage & lighting & sound equipment * The Pasco School District will provide only the facility, furniture and equipment normally found in a facility booked. No equipment or furniture may be moved from any district faciltiy without the Stage Manager's prior approval. Special Events Coverage Required Not Required Advance Deposit (if required) $ It is agreed that this application is made subject to Pasco School District Policies and Regulations for use of public school facilities. The undersigned agrees that these policies shall be strictly observed and accepts the entire responsibility for their enforcement. Further, the undersigned agrees to protect the premises and indemnify the Pasco School District for any damage of the building or grounds due to occupancy covered by this permit, including any attorney fees incurred in enforcing this agreement. It is understood and agreed by the applicant that this permit may be revoked or cancelled by the district at any time with or without cause and that in the event of such revocation or cancellation, the applicant shall have no claim or right to damages or reimbursement on account of any loss, damage, or expense whatsoever. The applicant further agrees to protect and indemnify the district and its officers and employees and hold them harmless from all claims, liabilities, damages or rights of action directly or indirectly growing out of the use of the premises covered by this application, including any attorney fees incurred. Applicant's Signature Manager's Signature Prepared by: Stage Manager/District Authorized/Renter Administrator Signature 4/1/ F Date Date Date

7 CHIAWANA HIGH SCHOOL/PASCO HIGH SCHOOL ATHLETIC FIELD AND STADIUM USE FEES/CHARGES SCHOOL YEAR Group #1 Group #2 Group #3 Week Days Week Days Week Days & Week Ends & Week Ends & Week Ends DIRECT CHARGES Event Manager 40.00/Hour 40.00/Hour 40.00/Hour Field Manager 40.00/Hour 40.00/Hour 40.00/Hour Electrician 45.00/Hour 45.00/Hour 45.00/Hour Custodian 40.00/Hour 40.00/Hour 40.00/Hour Back Gate Security 40.00/Hour 40.00/Hour 40.00/Hour Game Worker 40.00/Hour 40.00/Hour 40.00/Hour Field Microphones 20.00/Day 20.00/Day 20.00/Day Headphones 20.00/Day 20.00/Day 20.00/Day Concessions N/A N/A N/A Ambulance /Event Group #1 Group #2 Group #3 Week Days Week Days Week Days & Week Ends & Week Ends & Week Ends INDIRECT CHARGES Field Turf 75.00/Hour 75.00/Hour /Hour Track 15.00/Hour 35.00/Hour /Hour Field Lights /1 st hr /1 st hr /1 st hr /hr after 25.00/hr after 25.00/hr after Grandstand 17.00/Event 32.50/Event 54.00/Event Locker Room 13.50/Event 19.00/Event 32.50/Event Restroom 11.50/Event 17.00/Event 27.50/Event Press Box 11.50/Event 18.00/Event 34.00/Event Scoreboard 7.00/Hour 11.50/Hour 17.00/Hour Ticket Booth 7.00/Event 11.50/Event 17.00/Event Supplies /Event Football/Soccer Games will require the following charges/minimum 4 hours: Event Manager Electrician Custodian Field Turf Grandstand Press box Scoreboard Ticket Booth Supplies Restroom Locker room * Depending on event, the District may require additional fees. **Minimum 4 hours, $15/hour each additional hour

8 Pasco School District No W. Lewis Street Pasco, WA Compliance Statement for HB 1824, Youth Sports-Head Injury Polices (Please attach to any building/facility use request form) requests the use of the Pasco School District facilities for the following dates:., a private non-profit youth sports group, verifies all coaches, athletes and their parent/guardian have complied with mandated policies for the management of concussions and head injuries as prescribed by HB 1824, section 2. Attached is a proof of insurance under an accident and liability policy issued by an insurance company authorized to do business in Washington State covering any injury or damage with at least $50,000 due to bodily injury or death or one person and at least $100,000 due to bodily injury or death to two or more persons. Signed: Representative of Private/Non-Profit Youth Sports Group Date: *Note: Access to school facilities may not be granted until all requirements of this application are complete and approved by the district and/or designee. Revised 3/25/10