Facilities Use Request

Facilities Use Request

 

Name of Applicant___________________________________

 

Address of Applicant__________________________________

 

Organization________________________________________

 

Facilities Requested__________________________________

 

Date(s)/Time of intended use__________________________

 

Description of Activity _________________________________________________________________________________________________________________

 

Declaration of Applicant

  1.  I, the undersigned, hereby certify that I will personally be responsible on behalf of the applicant for any damages sustained by the school building, furniture, equipment, or grounds occurring through the occupancy or use of said building and/or grounds by the applicant, normal wear and tear exempted.
  2. I hereby that I have received and read the rules, regulations, conditions and terms of this application, will abide by them and will conform to all applicable provisions, rules, and regulations of the TMS Board of Education and its authorized agents which may be communicated to this applicant. 
  3. It is agreed that in the event this permit is canceled by the applicant no refund will be made and that changes in date or extension of time shall be made only as specified by the rules governing use of school facilities.
  4. In executing this declaration I certify that I have been duly authorized by the herein set forth applicant to act on its behalf in making application for use of said facilities.

 

Hold Harmless and Indemnification

The undersigned agrees to defend indemnify and hold harmless the Tatum Municipal Schools District, its board of education, agents and employees, individually and collectively, from and against all costs, losses, claims, actions and judgments arising from personal injuries, property damage or otherwise. However, causes that may arise from or be alleged to be caused by the undersigned’s use of occupancy of district facilities, furniture or equipment. The undersigned further agrees to provide a certificate of insurance for liability coverages satisfactory to the district. Insurance may be waived based on activity and facility requested.

 

 

Signature of representative___________________________

 

Date_______________________________________________

 

Address____________________________________________

 

Telephone___________________________________________

 

Recommendations/Approvals_____________________________________