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Request Form

Event Name: E-mail:
Primary Phone #:

    High School
    Middle School
    Collins Elementary

Event Date Requested

More Dates:
Event Time Requested
Start: End:

Specific Details

Name of Adult in Charge:
We wish entrance to the building at:
We will vacate the building by:
We be charging an admisions fee.
We expect an attendance of approximately people.

We require use of the following, and understand there is a charge of such use:
Stage Speaker's Stand
Special Lighting Ticket Table & Chairs
Piano Gymnasium Showers
Projector Folding Chairs
Large Folding Tables Custodian:Yes No

Additional Requests or Comments:
It is understood that School District activities have preference over outside activities in using
the school building and this request is subject to cancellationi if the requested facility is needed
for a school activity.

If this permission is granted, we agree to be responsible for any accidents or injuries sustained
by any person attending or participating in the program or activity for which we may use the
above-mentioned school facilities, and to be responsible for replacement in case of any damage
or loss incurred. furhter, in accordance with State requirements and Board policy, we agree that
there shall be no use of tobacco or controlled substances in the school building.