Laserfiche WebLink
GOLDENDALE SCHOOL DISTRICT NO. 404 <br />APPLICATION FOR USE OF SCHOOL FACILITIES <br />Your application will be confirmed or rejected within two weeks. Please type or clearly print and submit at least 15 days prior to <br />date(s) desired. <br />REGULATIONS: Please read before completing this application. <br />1. There is to be NO SMOKING ALC UOL ILLEGAL DRUGS, or WEAP NS in the school buildings or on school <br />property. <br />2. There is to be NO FOOD allowed except in specified areas. <br />3. The FIRE DEPARTMENT and POLICE having jurisdiction, are to be notified if LARGE CROWDS are expected. <br />4. All children associated with this Use of Facility must be supervised. <br />5. Renter is responsible to the Board of Directors of the district for supervision, use, and care of school property and herewith <br />assures the District that the character and nature of the activity anticipated will comply with School Board regulations and state <br />law. <br />6. The School District reserves the right to require that the FEE for use of any facility be PAID IN ADVANCE. <br />7. School district employees are not to be called for assistance by any group using school facilities. In the event of an emergency <br />and staff must respond to a group/person request, the School District reserves the right to bill the renter for any fees incurred. <br />8. The school district reserves the right to require liability insurance and a Certificate of Insurance prior to approval. <br />Group Making Request: <br />Date of Application: <br />VICIOUS Cycle Events Inc. <br />1/28/19 <br />Person or Agent: <br />Office Phone: <br />Jake Maedke <br />Home Phone: <br />509-750-0977 <br />Mailing Address: <br />Zip: <br />139 E ST SW Ephrata, WA 98823 <br />98823 <br />Building Requested: <br />Dates of facility use: <br />High School Parking Lot <br />4/14/19 <br />Purpose of Facility Use: <br />Rehearsal dates: <br />Cycle Event Staging/Parking <br />1. FACILITES_ REPUESTE0: <br />_ Classroom _ Gym _ Library _ Cafeteria _ Kitchen _ Other/ <br />2. TIME DURATION: From: 7 am To: 5 pm Time main doors open: <br />3. ADMISSION CHARGE: None X Adults:$ Students:$ <br />4. EQUIPMENT REIZ EI E§;TED: <br />Projector VCR Public Address Piano <br />Other equipment (specify): <br />5. :SPECIAL CON6iTlSERVICESE (specify). — <br />SIGNATURE OF APPLICANT/ RESPONSIBLE PARTY <br />FOR OFFICE USE ONLY. <br />1. APPLICATION: Approved or Rejected Rejection reaswi: <br />2. FEES FOR USE OF FACILITIES: $ <br />3. SPECIAL CONDITIONS/OTHER: <br />High School Parking Lot <br />Portable Stage Kitchen Equipment <br />(Basic Rental fees, plus custodian/cook overtime in excess of hours) <br />Approval Signature of Building Administrator <br />Date <br />Rev.9/07 <br />