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Application for Community use
Application for Community Use
 1)

Enter your organization's name here.

   
 2)

Enter Todays Date: MM/DD/YYYY

   
 3)

Enter your name here.

   
 4)

Applicant's Position in Organization

   
 5)

Enter your address (street, city, state, zip-code) here.

   
 6)

Enter your contact phone number here ### ###-####

   
 7)

Enter your email address here.

   
 8)Please choose a school location:

   
 9) 

Enter the date(s) your are requesting usage for.

4000 characters remaining
   
 10)

Enter the Day(s) of the week you are requesting usage for.

Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
 
   
 11)

Enter the start time as HH:MM am or pm.

   
 12)

Enter the end time as HH:MM am or pm.

   
 

13)

Fundraiser or Organizational Use?*If fundraising, a flyer must accompany this requrest and be pre-approved before your event is scheduled.   
13a)Describe your event
14)Activity open to:
 15)Admission Charge?

   
 16)

Estimated Number Attending:

*Over 100 Police/Fire Protection may be required

   
 17)Area(s) Requested (i.e. Auditorium, gym, cafe, kitchen, classroom(s), etc.   
 18)

A certificate of insurance for liability and property damage must be included with this application or upon notification of approval but no later than 5 days prior to the event. Applicant(s) agree to indemnify and hold harmless the Cromwell Board of Education, The Town of Cromwell, and any of their officers, employees, or agents from any and all liability arising from damage, loss, or injury to the person or property of those attending the function in or on school premises. The undersigned further declares that appropriate protection for the health, safety, and welfare of participants as required by the School District, Town of Cromwell, and State regulations shall be provided.  In addition, the undersigned user is personally responsible for all claims for damage or breakage incurred during the occupancy of the premises at the date and time herein stated. 

    
 19)

I am in receipt of or have read the Board of Education Policy, Section 1330, Community, Community Use of School Facilities with regards to regulations and fees and hereby certify that the organization which I represent, and/or the activity which we are sponsoring, fully meet the conditions set forth, and hereby agree to observe all of the rules and procedures outlined in the policy. I understand that I, or my representative, may meet with a school representative(s) at the conclusion of our event to verify the facilities condition.

    
 20)Applicant's Signature: Entering your name is acknowledging the above statement and will be considered an electronic signature   
 21)Date   
 22)

NOTES:

 

   
       
       
       


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