Usage of School Facilities
Aurora Waldorf School525 West Falls Rd, West Falls, NY 14052
Room
Start Time
End Time
Fee/Hr
Mo mm/dd
Tu mm/dd
We mm/dd
Th mm/dd
Fri mm/dd
Sa mm/dd
Su mm/dd
Total/Fee
1
2
3
4
5
6
7
8
9
10
Check here if you are using page 2 for multiple day or multiple room events, or requests for audio/visual equipment or special setup.
Type of Activity
*
Estimated Attendance
*
Name of Organization
*
Phone
*
Please enter a valid phone number.
Name of Representative
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Type of Organization
Profit-making Organization
Non-Profit Organization
Amount of liability insurance $
Will admission be charged, donations collected, or funds raised?
Yes
No
Audiovisual equipment request:
Other requests:
It is agreed that only the facilities listed will be used by our organization, only at the times requested, and only in accordance with the rules attached to this form. It is further agreed that the organization will hold Aurora Waldorf School harmless and defend it from any and all claims arising from the use of the building and equipment and from any injury or loss to any member of the organization and any participant, including the cost of defense. Insurance coverage is mandatory.
Signature of Organization Representative
Clear
Date
-
Month
-
Day
Year
Date Picker Icon
For Administration Use Only:
Recommended
Not Recommended
Remarks
Date
-
Month
-
Day
Year
Date Picker Icon
Signature of teacher(s) as needed
Clear
Date
-
Month
-
Day
Year
Date Picker Icon
Signature of Administrator
Clear
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Submit
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Should be Empty: