APPLICATIONS MUST BE SUBMITTED TEN DAYS BEFORE

THE MONTHLY BOARD OF EDUCATION MEETING.

PLEASE DO NOT SCHEDULE YOUR ACTIVITY BEFORE APPROVAL HAS BEEN GIVEN.

Date of Application:

We hereby make application for the use of property of (list facility - cafeteria, elementary gym, etc.?)

Ludlow Independent Schools, for:

(basketball practice, cheerleading tryouts, free-throw contest, etc.)

, from to .

Day(s) – Mon, Tues, etc. Date(s) – list allStartTime (a.m./p.m.)End Time

The following people will supervise and be responsible while this activity is in progress:

# of Ludlow Residents # of Non-Ludlow Residents

PRIORITY IS GIVEN TO SCHOOL SPONSORED TEAMS.

All organizations using a school facility will be responsible for a fee of$10.00 per hour for a custodian if the facility is used during non-custodial hours. If the facility is used during custodial hours, the $10.00 per hour fee will be waived. This fee does not apply to use of the elementary gym, unless the group does not vacate the premises at the specified time, and/or leaves the gym in disarray upon departure. Use of Ludlow Board of Education equipment, such as stoves, ovens or mechanically operated devices is prohibited without expressed written permission.

I have read and understand, Ludlow Independent Schools policy on Community Use of Facilities, and by signing below, I hereby affirm that: (i) I am twenty-one (21) years of age or older; (ii) I have the authority to make this Facility Request on behalf of the Requesting Organization; (iii) The individual named for the Requesting Organization shall be responsible for supervising the assigned area during the entire time it is in use; (iv) The Requesting Organization agrees to assume any and all liability for injury to individuals or property by reason of the lease of Board property and that the Requesting Organization agrees to indemnify and save harmless Ludlow Board of Education/Ludlow Independent Schools, its Board Members, employees, and agents from any loss or damage, thereby including reasonable attorney fees; and (v) That prior to the start of the scheduled event, the Requesting Organization agrees to provide the Superintendent with an insurance certificate of liability naming Ludlow Board of Education/Ludlow Independent Schools as Additional Insured.

Signature and TitleRequesting Organization

AddressCityStateZip

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Home and Cell Phone NumbersWork Phone Number

Email AddressAlternate Email Address

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