1500-F1 Use of Facilities Application

Application for Use of School Buildings and/or Facilities

We have read the school law which governs the use of public-school properties and also the attached regulations established by the Brentwood Board of Education regarding the care and usage of school facilities. We agree to abide by the law and the local regulations in every aspect. This application must be submitted with all the information as requested; failure to do so will delay the processing of your request. Certificate of Insurance must accompany application. This certificate must name the Brentwood School District as additional insured. It is the sole responsibility of the applicant to maintain sufficient insurance coverage throughout the period of use requested and to comply with all laws and District policies regarding the proposed use of facilities.

(Name of Facility User)_____________________ does covenant and agree to defend, indemnify and hold harmless the Brentwood Union Free School District from and against any and all liability, loss, damages, claims or actions (including costs and attorney’s fees) for bodily injury and/or property damage, to the extent permissible by law, arising out of or in any way connected with the actual or proposed use of Brentwood Union Free School District property, facilities and/or services, including but not limited to bodily injury to any employee, invitee, guest, spectator, contractor or subcontractor of _______________________ (Facility User).

(Facility User)____________________ understands and agrees that its use of Brentwood School District property and facilities includes, but is not limited to, all areas identified in the application and/or permit, and sidewalks, walkways, parking lots, entrances, stairs, and all other areas incidental to and/or connected with the use of the premises (hereinafter referred to as the “incidental areas”). The Facility User agrees that its indemnity and insurance obligations extend to the areas identified in the application and/or permit and any and all incidental areas.

_______________________________ __________________________________Print name Signature of Organization’s Representative

SCHOOL/BUILDING REQUESTED: ___________________________ DATE OF APPLICATION:______________

Nature of Event:___________________________________________________________________________________________

Number of Participants Expected:_________________, Adults:_____________________ Children:________________

Is There an Admission Fee Charged? Yes______ No______

Will items/services be sold: Yes______ No______

If items will be sold, what will the proceeds be used for: __________________________________________________________________________________________________

Will the activity require the use of the kitchen? Yes______ No______

If the use of the kitchen is required, this form must be forwarded to the School Lunch Manager for assignment of appropriate staff. Only those authorized by the School Lunch Manager and/or the Superintendent of Schools may operate kitchen equipment. Participation of other individuals shall be limited to the serving line

NOTE:If the building is to be used on Saturday and/or Sunday the Organization using the building will be charged for overtime custodial services and/or security fees.

 

 

 

The following person has agreed to assume responsibility for the facilities while they are being used by our organization. The person responsible will ensure that at least one individual associated with the group (i.e., coach, volunteer) who is AED/CPR trained and certified will be on site and present during any activity taking place on District property, at all times. (see F6 – AED Location List).  Event Supervisor:____________________________ ________________________________ Print Name Signature Address:_______________________________ _____________ ___________________ Street City/Town State/Zip Phone:___________________________________ Email:_________________________________ Name of Organization:______________________________________________________________

Day(s) of Event	Date(s) of Event	Time of Event	Official Use Only
¨ Monday ¨ Tuesday ¨ Wednesday ¨ Thursday ¨ Friday ¨ Saturday ¨ Sunday	From:_____/_____/_____ M D Y To:_____/_____/_____ M D Y	From:________________ AM or PM To:___________________ AM or PM	Check when submitted by the organization ____ Insurance Cert. ____ Organization Roster w/Officers ____Hold Harmless ____Not for Profit Proof ____CG 20 Form

AREAS TO BE USED (Check all that apply)
¨ Auditorium	¨ Classrooms Please List:	¨ Cafeteria ¨ Large ¨ Small	¨ Kitchen	¨ Other Explain____________
¨ Baseball Field	¨ Football Field	¨ Tennis Court	¨ Soccer Field	¨ Gymnasium
The Athletic Director must approve for use of the Baseball, Football or Soccer Fields, Tennis Courts and Gymnasium.   ¨ APPROVED ¨  DISAPPROVED   Athletic Director Signature:_______________________________ Date:__________________________

Audiovisual Needs ¨ Stage or Auditorium Lighting ¨ Computer/Laptop for Smart Boards ¨ Audio set-up ¨ Other needs (please specify): I understand that the requests for these services will incur an additional cost. ________ (Please Initial) *If necessary, provide detailed information on back.

 

Kitchen Needs ¨ Oven/Stove ¨ Cook/ Chef ¨ Refrigeration ¨ Food Service Worker ¨ Other needs (please specify): I understand that the requests for these services will incur an additional cost. ________ (Please Initial) *If necessary, provide detailed information on back.

¨ APPROVED ¨ DISAPPROVED

Principal Signature:____________________________________________ Date:_________________________

Approved by the Board of Education: 08/17/17 Revision approved by the BOE: 10/19/23

Approved by the Board of Education: 11/21/19 Revision approved by the BOE: 09/26/24

Approved by the Board of Education: 03/18/21 Revision approved by the BOE: 07/08/25

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