Etiwanda School District   "Excellence in Education"
   6061 East Avenue, Etiwanda, CA 91739
   (909) 899-2451  Fax (909) 899-1235
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Etiwanda School District Facility Use Form


Submission of this form does not constitute approval. A $30 non-refundable application fee is required for Category 1 and Category 3 organizations as defined in Board Policy 1330. For a list of Use of Facilities Fees, click here.

Date:   (allow 2 weeks for processing)

APPLICANT / ORGANIZATION INFORMATION
Name of Organization:
Billing Address:   City:   State:  Zip:
Contact Name:   Phone:   Email:
Organization Type:

       
EVENT INFORMATION
Event:
Location Requested:
Dates Requested:
Frequency:
Start Date:
Start Time: :
Help me decide!

End Time: :  

There is a possibility that a District program may pre-empt your scheduled use. In the rare event you are pre-empted, an alternate location will be offered or a full refund for that use will be granted. The District shall not be held liable in any way for any pre-emption.

Approximate Event Size (# of participants):         Age of Participants:  to
Type of Facility Requested:     (# of rooms    
Additional Items Requested:  (#  (#  (# )
Notes:

INSURANCE REQUIREMENTS
A Certificate of Liability Insurance with a minimum of $1,000,000 is required with the submittal of the application listing Etiwanda School District as additional insured. A letter of Endorsement with said coverage must also accompany the Certificate of Liability.

RELEASE, HOLD HARMLESS AGREEMENT AND COVENANT NOT TO SUE
I, [NAME] , in consideration of being permitted to use facilities of the Etiwanda School District, in connection with [ORGANIZATION] (organization) between the dates of [START DATE] and [END DATE] do hereby covenant and agree that the Etiwanda School District, its officers, employees, agents, Board Members and representatives (hereafter collectively “District”) shall not be liable for any claims for loss, damage, personal injury or liability of any kind caused by or arising from my used of the premises of the District, or any part hereof, or any building, structure or improvement thereon, or arising from any act or omission of the undersigned, nor shall the District be liable for any claims for loss, damage, wrongful death or personal injury due to negligence of any cause whatsoever to the person or property of the undersigned while entering upon or using said premises of any part thereof, or to any property of the undersigned stored or placed therein. Notwithstanding anything to the contrary herein contained an irrespective of any insurance carried by the undersigned, the undersigned hereby releases and agrees to defend, indemnify, covenant not to sue, and hold the District and said premises harmless from any and all claims for damages or liability due to negligence of whatsoever nature arising out of or in connection with the use of occupancy of the premises of the District, or arising from the state of condition of said premises or any part thereof.


LETTER OF AUTHORIZATION FROM ORGANIZATION MUST BE ATTACHED IF APPLICABLE.
Any person applying for the use of school property on behalf of any society, group, or organization shall be a member of the applicant group and, unless he or she is an officer of the group, must present written authorization on organization’s letterhead, to make the application.

The governing board of any school district may, in its discretion, consider any statement of information or written authorization made pursuant to the requirements of this section as being continuing in effect for the purposes of this section for the period of one year from the date of the statement of information or written authorization.


  1. Rooms have maximum occupancy requirements. At no time are facilities to be over the maximum occupancy allowed by the fire department. This creates a safety hazard. Should an organization be over the maximum participants allowed in any room, the organization will need to contact parents to arrange pick up and supervision.
  2. Organizations are responsible for their participants and their actions. At no time should a student be left alone and unsupervised.
  3. Organizations need to plan to be finished at the time designated on the use-of-facility form. Additional charges will be assessed in the event time is extended (hourly rate + closing fee, if applicable.)
  4. Never leave the facility open without appropriate adult supervision.
  5. Ensure that all doors are closed tight and locked (including bathrooms), that lights are out and gates are closed and locked.
  6. Never allow children to run and play in the multipurpose rooms or on the stages.
  7. Kitchen facilities are not available unless previously approved with child nutrition staff present.
  8. Please help by picking up all trash after your meetings. Trashcans are available for your use.
  9. DO NOT TAKE DOWN OR PUT UP TABLES OR BENCHES! Special handling is required.
  10. Telephones are not available for your use. Bring a cell phone.
  11. Use of fields and playground (for soccer, basketball, etc.) does not include restroom facilities.
  12. CLEATS ARE NOT ALLOWED ON FIELDS.
  13. Portable lights are prohibited unless approved by District.
  14. Stage, sound equipment and screens are not available for use.
  15. Do not leave any items (even if your organization is using the facility weekly.)
  16. Organizations are only allowed in areas that have been approved on the use-of-facility form.
All school facilities, including fields and parking lots are tobacco free and drug free. Smoking and alcohol are not allowed anywhere on the premises.






Etiwanda School District