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Use this form to request the use of a building/facility in the Kewaskum School District (please use the Kewaskum Theatre Request form if you are requesting the Theatre). Please consider submitting your request to provide us with enough lead time to honor it. Additionally, requests should not be placed more that one year in advance of the event date.
The submitted form will be reveiwed and approved by Vickie Plachinski. If space is available it will be further approved by Jason Piittmann and Jim Palmer. Upon final approval it will be added to the appropriate Kewaskum School District website calendar.
District Staff: Do not complete this form. Complete the Building/Facility Use Request Form on the District Intranet. Staff requests submitted here will not be approved.
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If not a District event, is organization profit or non-profit? |
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Note: The rental of the theatre to profit organizations is $25 per hour.
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Event Description:
**Note: This description will be displayed on the Kewaskum School District website calendar. |
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Will admission be charged? |
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If outside organization-Proof of insurance on file with the District? |
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If outside organization - insurance lists Kewaskum School District for "additonal insured"? |
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Chaperone(s) or Supervisor(s): |
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School Building(s) Requested: |
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(1 required) |
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Which area(s) or room(s) is/are needed for the event? |
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Special equipment requested: (Please be as specific as possible. Do you need tables/chairs? If so, how many? If you have any questions or need a special setup, contact Jim Palmer at 262-483-4701 or email him at jpalmer@ksd.k12.wi.us
An answer is required here so type None if you don't need any special equipment. |
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It is hereby understood:
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that school activities have priority for the use of any building;
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that tobacco/alcohol usage is prohibited as per Board Policy;
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that the applicant and/or organization named above will be responsible for the proper use of the facilities being used, and if there are damages from this use, the applicant and/or organization will be responsible for payment of such damages.
INDEMNIFICATION AGREEMENT
The applicant agrees to indemnify and hold the School District harmless, from any and all claims by, or on behalf of, any persons, firms pursuant to the application or arising out of any accident or injury which occurs on school property during, or arising out of the applicant's use of school property pursuant to this application. Applicant further agrees to indemnify the School District for any attorney fees or other expenses incurred by the School District in defending any claims arising out of or during the course of applicant's use of school property pursuant to this application.
Please Note: approvals of your request may come in email form from an address ending with ksd.k12.wi.us or notifications@rschool.com
Clicking submit signifies agreement
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