Facilities Request Form

CODE: KG-R

Maine School Administrative District No. 31

FACILITIES REQUEST FORM

Date:__________________________ Facility Requested:____________________________________________________

Organization /Address: __________________________________________________________________________________________

Non Profit? Yes__________ No ___________

Contact Person:____________________________________________ Telephone #: ___________________________

Activity Supervisor:_________________________________________ Telephone #: __________________________

Type of Activity/Special Equipment Needed: _________________________________________________________________________

______________________________________________________________________________________________________________

Date Requested:_____________________________ Time From / To:___________________________________________

M.S.A.D. #31 USE OF SCHOOL FACILITIES REGULATIONS:

1. The adult making the request must be responsible for use of school facilities and be present during the activity being held.

Approval must be initiated through the Principal’s Office.

2. A group or individual using school facilities and equipment will be responsible for adequate supervision of the buildings and

grounds and must be willing and financially able to guarantee payment for any damage.

3. Minor construction, decorations, etc. must be approved in advance and restored to original condition as soon as possible

after the event.

4. Alcoholic beverages will not be allowed in the buildings or on the premises.

5. An outside event or activity will not interfere in any way (or be given preference) over a school activity.

6. Upon review of the completed FACILITIES REQUEST FORM, the Superintendent of Schools will determine an appropriate

rental fee (to cover expenses) as provided by the Board Policy Committee’s USE OF SCHOOL FACILITIES, File KG.

7. Building temperatures will be determined by M.S.A.D. #31.

8. Use of tobacco products will not be allowed in the buildings or on the premises.

9. A janitor, or approved designee, must be in the building whenever the building is used. A cafeteria worker must be present

whenever the kitchen and/or kitchen equipment is being used. Non-School organizations will be charged for required personnel.

Other requests may require special arrangements with the school.

10. Insurance requirements are outlined on reverse side of this facilities request form.

I HAVE READ AND UNDERSTAND THE ABOVE REGULATIONS:

Signature:_____________________________________________________ Date: ________________________

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OFFICE USE ONLY

___________________________________________ ____________________________________________

Principal’s Approval Date B & G Supervisor Notified Date

__________________________________________ ____________________________________________

Superintendent’s Approval Date Kitchen Supervisor Notified Date

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FEE: _______________________________________

It has become necessary for us to update our insurance requirements for those who use M.S.A.D. #31 facilities for special purposes. In the past, we have not had a set dollar amount required for comprehensive general liability. Therefore, individual groups have purchased their own liability insurance in varying amounts. Subsequently, we have devised the following guidelines.

We will consider each request individually, determining at that time whether insurance is required and, if so, whether it is in a high risk or low risk category. High-risk categories will require minimum insurance of $1,000,000. Those in the low risk category will require minimum insurance of $300,000.

If you wish to use our facilities, but are unable, either because of a lack of appropriate coverage or an exorbitant premium, $1,000,000 liability coverage is available through Maine School Management Association for special, one-time events. A form is available at the Superintendent’s office. We realize that liability insurance can be a financial hardship for some groups and appreciate your cooperation in this matter. Please feel free to call if you have any questions.

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In the event you are required, as determined by M.S.A.D. #31, to provide a Certificate of Insurance as evidence of Comprehensive General Liability coverage, please fill out the following:

This Addendum becomes part of any Use Agreement by and between the Event Sponsor and M.S.A.D. #31.

EVENT SPONSOR _____________________________________________________________

IT IS AGREED that in consideration for allowing the rental of school facilities and in full recognition of the school board’s fiduciary responsibility to protect school property and assets, the Event Sponsor (Tenant User) hereby covenants and agrees at all times to indemnify and hold harmless M.S.A.D. #31, its School Board, officers and employees, to the fullest extent permitted by law, from any and all claims, damages, losses and expenses, including, but not limited to, reasonable attorneys’ fees and legal costs arising out of the use of these rental premises and all school facilities by the Event Sponsor (Tenant User), its officers, employees, agents, representatives, contractors, customers, guests, and invitees.

The Event Sponsor will provide a Certificate of Insurance as evidence of Commercial General Liability coverage, naming M.S.A.D. #31 as an Additional Insured, with limits to be determined by M.S.A.D. #31 at the time of the request.

EVIDENCE OF INSURANCE (Please check one):

_____ The Event Sponsor maintains comprehensive general liability (CGL) coverage in the required amounts, as determined by

M.S.A.D. #31. A Certificate of Insurance will be provided before any use of the facility, endorsed to name M.S.A.D. #31 as an

Additional Insured.

_____ The Event Sponsor hereby applies for $1 million CGL coverage for the following use of the facility. (An application may be

obtained in the Superintendent’s Office).

______________________________________________________________________________

Signature of Legal Representative of Event Sponsor Date

______________________________________________________________________________

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