HARTFORD CENTRAL SCHOOL

Revised 9/29/04

REQUEST FOR USE OF BUILDING AND/OR SCHOOL GROUNDS

 

Please complete items 1-10 and return to the:                        Principal, Grades 6-12

                        Hartford Central School

                        PO Box 79

                        Hartford, NY 12838

 

  1. Organization or Group Making Request: ______________________________________________
  2. Name and Phone Number of Contact Person: ___________________________________________
  3. Type of Activity (e.g. dance, meeting, etc.): ____________________________________________
  4. Total Number of Participants: _________________  5.  Date(s) requested: _____________________
  1. Time Requested: ___________________________  7.  Circle all days that apply: S  M  T  W  TH  F  S
  1. All events require a custodial to be on duty unless an acceptable alternative is requested and approved.  Do you wish to request an alternative:               Yes               No
  2. If you indicated Yes, please describe why you do not need a custodian:

 

 

  1. Specific Facility Requested:

Check all that apply:

_____ Classroom

_____ Library

_____ Café/Auditorium

_____ Gym

_____ Chairs

_______How Many

_____ Café Tables

_______ How Many

____ Sound System

____ Podium

____ Kitchen

 

Other (Please List:)

 

Please contact Mrs. Ross as soon as possible at 518-632-5222, Ext. 20 or

Gary Jones at Ext. 23 if there is a cancellation.

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FOR OFFICE USE ONLY

Date Received

 

Permission is NOT granted for the following reasons:

 

 

 

Permission is hereby granted for the use of the requested area(s) subject to the general provisions stated on the back of this form and any such provision(s) indicated below:

 

 

 

 

 

 

 

Principal

 

Athletic Director (Gym)

 

Date

Copy to:            Gary Jones, Custodian         Athletic Director          Cafeteria Manager

Organization’s Contact Person: ________________________________________________________

 

 

The buildings and facilities of the Hartford Central School District represent a significant investment by the people of the school district. Although their main purpose is for the education of our children, common sense and a desire to use these facilities to their utmost efficiency, enable us to make them as available as possible for use by our community . . . that is, the entire school district . . . whenever it does not interfere with their normal educational purposes.

So that its use as an educational institution may not be impaired, groups not directly connected with the school should be aware of the following general provisions:

  1. All building request must be submitted to the building principal no later than 48 hours prior to the event.  Any request submitted less than 48 hours prior to the event is not guaranteed approval and can be denied.
  2. Any granted date is subject to cancellation, or the area, which has been approved for use, may have to be changed, if it becomes absolutely NECESSARY to use the date and place for a SCHOOL event. 
  3. Any group wishing to exhibit posters or any other forms of advertisements must obtain written permission from the building principal prior to any displaying.
  4. Any group using the school and/or grounds must accept responsibility for any injuries occurring during its use, which are not the result of negligence on the part of the school.
  5. Any group using the school and/or grounds must accept financial responsibility for damage done to school property by persons involved in the activity.
  6. All activities in the school and/or grounds MUST BE under constant supervision by qualified adults, and the group must remain in the location originally approved by the building principal.
  7. Equipment must be turned off, windows closed, lights out, doors, locked, etc., at the end of the activity.
  8. The group requesting permission to use the school and/or ground is responsible for policing (i.e., drinking ban, presence of unauthorized person, presence in areas of school not covered by permission).

9.       While our custodians clean the school as part of their usual routine, groups using the school and/or grounds should be expected to leave the facilities in good order. Where it is necessary to have a custodian on duty, or where a custodian may be required to put in extra time after his regular week's work, in order to have the facilities ready for the regular school day, a charge may be levied against the group using the facilities.

  1. Effective September 1, 1991, the principal or other person in charge of any public or private school or educational institution (other than college and universities) shall require the teacher or person in charge of any after school program, event or performance which takes place in a school and which is attended by persons who do not regularly attend classes within the school, to notify such persons in attendance at the beginning of such program, event or performance of the proper procedures to evacuate the building in an orderly and timely manner in the event of a fire emergency. The required notification shall be given to the attendees at any single occurrence, and at each occurrence where the same presentation is given to a different audience. Where a program such as an adult education class runs several weeks, the notice shall be given at least at the first meeting.

 

If any of the conditions of the building request form are violated, the ability for the group to use the school buildings and/or grounds will be in jeopardy.  Two or more violations will result in the group losing the ability to utilize the school building and/or grounds.

 

I have read and understand the requirements and conditions of using the school building and/or grounds.  I understand that a failure to abide by these requirements can result in the loss of building use privileges.

 

Signature:_____________________________________________________   

 

Date:_______________