Kewaskum Theatre Use Application - Kewaskum School District

Kewaskum Theatre Use Application:

Use this form to request the use of The Kewaskum Theatre (please use the Building/Facility Use Request form if you are requesting any other facility). 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 Use Theatre Request Form on the District Intranet. Staff requests submitted here will not be approved.

Today's Date:

Name:

Name of Organizaton if not District event:

If not a District event, is organization profit or non-profit?

Phone:

Date or Dates Requested (Please list all dates needed.)

Name of Event:
*Note: This information is needed for the Kewaskum School District website calendar.
For example: KHS Play: "Bye Bye Birdie"

Time of Event-Please state the start and end time:

Time theatre doors open to the public:
Note: Enter "N/A" if this does not apply.

10.

Time Facility Needed-Please state the start and end times:

11.

Event Description:
*Note: This description will be displayed on the Kewaskum School District website calendar. Please include the following if it applies:

Ticket information
- Price
- Where can they be purchased?
Contact information-Who can be contacted for ticket information?

12.

Estimated Number of People in Attendance:

13.

Will admission be charged?

Yes

14.

Are ushers needed?

	Yes
	No

15.

If ushers are needed, how many and what time(s)?

16.

If outside organization-Proof of insurance on file with the District?

17.

If outside organization-Insurance lists Kewaskum School District for "additional insured"?

18.

Name(s) of Chaperone(s) or Supervisor(s):

19.

Phone number(s) and email address(es) of chaperone(s) or supervisor(s):

20.

Special equipment requested: (Please be as specific as possible. Please contact Jim Palmer at 262-483-4701 or email him at jpalmer@ksd.k12.wi.us if you check any of the following items.)

	Computer port to connect to projector			Laptop
	DVD Player			Podium
	Piano			Risers
	Chairs			Sound System (Microphones)
	Lighting System (Stage Lights)			Projector and Projection Screen

21.

LIst any other special needs if not listed above.

It is hereby understood:

that food and/or beverages are not allowed in the theatre.
that school activities have priority for the use of any building;
that tobacco/alcohol usage is prohibited as per Board Policy;
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@rschooltoday

Clicking submit signifies agreement.

* Enter Your Email Address:

Type in the text that you see above:

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