REQUEST FOR USE OF FACILITY

Transcription

1 REQUEST FOR USE OF FACILITY PLEASE TYPE OR PRINT (PRESS HARD) SEND TOP TWO COPIES DIRECTLY TO THE SCHOOL/FACILITY REQUESTED 21 DAYS PRIOR TO FIRST DATE REQUESTED Name of Organization Responsible Individual Street Address City State Zip Telephone: Office Home Cell School/Facility Requested Rooms or Facility Desired Equipment Needed Other Comments Name of Program Purpose of Program Number of People Expected Admission Fee or Donation (s) Needed Time From Time To KG-E C.O. Form #24 The above-named individual/organization hereby makes application for use of said facility. I understand that the full rental fee and the estimated custodial, audio, maintenance, and cafeteria fees must be deposited (certified check or money order) no later than two (2) weeks before the first date requested and a final bill will be sent after each event. Those organizations using facilities on a regular basis will be rendered monthly bills. In the event of cancellation, written notice must be provided to the principal no later than the business day before the event or the full deposit may be forfeited. 1 further understand that the Isle of Wight County School Board, its agents, successors and/or assignees, make no warranties, either expressed and/or implied, regarding the condition of property being used by the applicant. Also, the Isle of Wight County School Board, its agents, successors, and/or assignees, are not responsible for providing air conditioning, heating, special lighting, furniture set-up, or any other services whatsoever, in order to accommodate and/or facilitate the applicant's use of the facility, except that the Isle of Wight County School Board will provide limited custodial, audio, maintenance, and cafeteria services, if applicable. The applicant shall assume full responsibility for any loss, damage, and/or injury to any person and/or property caused by applicant, its agents, assignees, guests, and/or invitees, while the property is being used by the applicant. Furthermore, the applicant agrees to hold Isle of Wight County School Board harmless from any claims, suits, and/or actions whatsoever and however caused, for injuries suffered by the applicant, its agents, assignees, guests, and/or invitees, while the property is being used. The applicant shall comply with all applicable rates and regulations of the Isle of Wight County School Board, which are incorporated herein by reference. The applicant also understands that the possession and/or use of alcoholic beverages is prohibited on all school property and the use of tobacco and tobacco products is prohibited in all buildings. For further information, call (757) Applicant Signature **********************************************SCHOOL BOARD USE ONLY*********************************************** PRINCIPAL Insurance Verified Approved Disapproved Comments Estimated additional hours: Custodial Audio Technician Cafeteria Maintenance FACILITIES DEPARTMENT Approved Disapproved Comments FINANCE DEPARTMENT REMIT PAYMENT TO: Rental Fees $ 820 W. Main Street Custodial Fee Estimate Smithfield, Virginia Audio Technician Fee Estimate Attn: Finance Department Cafeteria Fee Estimate Maintenance Fee Estimate Total Deposit Due $ NO LATER THAN

2 FACILITY USE RENTAL FEES KG-E (Page 2) School Related Groups (hourly rates) (Schools) High Schools, Middle Schools, Elementary Schools (Areas) Football Stadium, Auditorium, Gym, Cafeteria, Kitchen, Library, Classrooms Tennis Courts, Grounds, Practice Fields, Parking Lots Football Stadium w/lights - $45 w/o lights - $35 Auditorium (high schools) $45 (middle schools) $35 Gym (high schools) $40 (middle schools) $25 Cafeteria $25 Kitchen $25 Library $25 Classrooms $17 Tennis Courts (high schools) $10 Grounds $10 Practice Fields $20 Parking Lots $20 Gym $23 Cafeteria $17 Kitchen $17 Library $17 Classrooms $12 Grounds $10 Parking Lots $20 (Fees may be waived for these groups, dependent upon actual costs involved. See regulation KG-R) Non-School Related Groups Non-Profit (hourly rates) Football Stadium w/lights - $91 w/o lights - $81 Auditorium (high schools) $91 (middle schools) $76 Gym (high schools) $88 (middle schools) $73 Cafeteria $34 Kitchen $34 Library $34 Classrooms $21 Tennis Courts (high schools) $25 Grounds $25 Practice Fields $40 Parking Lots $40 Gym $29 Cafeteria $29 Kitchen $29 Library $29 Classrooms $21 Grounds $25 Parking Lots $40

3 (Page 3) Non-School Related Groups For-Profit (hourly rates) Football Stadium w/lights - $135 w/o lights - $125 Auditorium (high schools) $135 (middle schools) $110 Gym (high schools) $120 (middle schools) $110 Cafeteria $ 70 Kitchen $ 70 Library $ 70 Classrooms $ 60 Tennis Courts (high schools) $ 60 Grounds $ 60 Practice Fields $ 65 Parking Lots $ 70 Gym $ 60 Cafeteria $ 60 Kitchen $ 60 Library $ 60 Classrooms $ 55 Grounds $ 60 Parking Lots $ 70 Personnel costs and maintenance supply fee are as follows: Personnel costs shall be the actual overtime hourly rate (including benefits) for employee(s) assigned to the activity, (if additional work time occurs) Custodians, Prevailing custodial rates Auditorium technician, Overtime plus benefits Food service manager/manager s designee when kitchen used, Overtime plus benefits Other food service staff as needed, Overtime plus benefits Other Staff as needed, Overtime plus benefits Maintenance supply fee (for restroom supplies, trash removal, cleaning supplies, etc., when auditorium, gym, cafeteria, or football stadium are used) Notes: $ 6/hour or portion thereof for 1-49 people $15/hour or portion thereof for persons $27/hour or portion thereof for 150 or more persons 1. Rental rates for areas not previously listed will be determined by the school principal and superintendent, subject to board approval. 2. Neither rental fees nor maintenance supply fee shall be collected from the following groups, but personnel costs must be paid by either the school or group using the school: a. School related groups composed of school personnel that are considered to be educational professional organizations or directly connected to school division programs (e.g. Booster Club, P.T.A., alumni groups); groups, clubs or organizations consisting primarily of Isle of Wight County Public School students b. School sponsored activities under direction of the school principal (e.g., athletic events, school clubs, Performing Arts).

4 (Page 4) 3. Rental fees are waived for the groups listed below but personnel costs and maintenance supply fee are to be collected: a. Approved, properly sponsored youth groups, e.g., boy/girl scouts and 4-H clubs, b. Local government and civic meetings, c. Activities by local talent and nonprofessionals sponsored by civic groups when net profit is used for school betterment projects, and d. Fire departments, rescue squads, and life saving crews of Isle of Wight County. Charges to be paid in advance by applicant: Estimated Charges: (1) Maintenance supply fee: (for restroom supplies, trash removal, cleaning supplies, etc., when auditorium, gym, cafeteria, or football stadium are used) $ 6/hour or portion thereof for 1-49 people $15/hour or portion thereof for persons $27/hour or portion thereof for 150 or more persons SUBTOTAL (1) (1) (2) Custodial - prevailing rates Other SUBTOTAL (2) $ (2) (3) Auditorium Technician, Overtime Rate (including benefits) (A) (B) A. Minimum of one for auditorium use (Name) (Hours) B. Second technician (Name) (Hours) Social Security Number(s) (A) (B) SUBTOTAL (3) (3) (4) Food Service, Overtime Rate (including benefits) (A) (B) A. Manager/Manager s Designee Name (Hours) Social Security Number(s) (A) (B) SUBTOTAL (4) (4) (5) Other Position(s) Overtime Rate (including benefits) (A) (B) A. Position (Name) (Hours) B. Position (Name) (Hours) Social Security Number(s) (A) (B) SUBTOTAL (5) (5) (6) Rental Fee Describe: Hours x fee: SUBTOTAL (6) (6) TOTAL: Lines (1) - (6) (Make check payable to the Isle of Wight County School Board) To be completed by Principal: Application approved: Application rejected: Applicant notified: Charges collected in advance for personnel services and rental fees $

5 (Page 5) Remit funds at the end of each month to the Finance Office along with a copy of this form. Submit time sheet for all personnel services to the Payroll Office. Principal s Signature Issued: August 12, 1993 Revised: August 14, 1997 Revised: October 11, 2001 Revised: August 12, 2004 Revised: October 8, 2009 Revised: February 9, 2012