Stafford Township School District Application for School Building Use by Outside Groups Class I and II and Other Non-School Events

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1 Approvals: (For Administrative Use Only) Stafford Township School District Application for School Building Use by Outside Groups Class I and II and Other Non-School Events Principal Initials Date SBA Initials Date *All school building use is covered by Policy and Regulation 7510 (a copy of which was provided with this application). Please read it carefully. *This form should be returned to the Principal/Main Office of the building of which you are requesting use (for the Administration Building, please bring your request to the Board Secretary/School Business Administrator s Office). Please note that this application pertains to school building use only. If you wish to use the Stafford Township Arts Center, please complete the Building Use Application STAC. Further, if you are a school employee seeking to use facilities for a school event, please contact the building Principal. Event Information Event Title: Event Description (Please give a general event description AND indicate: the number of participants; whether food/drink is being served): Number of Participants: Will food/drink be served? Adults Children Yes No Requested Location (please circle one): Admin Bldg; Intermediate; McKinley; Ocean Acres; Oxycocus; PLC Requested Room(s): Event Date(s): Start Time: End Time: Setup Begin Time: Breakdown End Time: Organization Information Organization Name: Contact Name: Day-Time Phone: Cell Phone: Billing Address: Mailing Address: *The District security procedures require that the facility doors remain locked at all times. Therefore, a representative from your group must be designated to meet the custodian 15 minutes in advance of your event start time to open the facility doors. Thereafter, the representative must remain at the doors to let your event attendees inside. Finally, the representative must notify the custodian when your group leaves the facility. If your group s representative for that purpose is someone other than the individual named above, please indicate the name of the individual:. If your group wants to submit an alternate security plan, please contact the Building Principal. TLS Application Page 1 of 3

2 Insurance Information Company: Company Policy No: Coverage: Coverage Dates: to A valid Certificate of Insurance meeting the requirements set forth in Policy and Regulation 7510 MUST be attached. Failure to attach the Certificate of Insurance will result in an application rejection. In addition, the Insurance must be valid for all dates of requested use. If not, your application will only be approved for the dates during which the insurance is valid. It is your obligation to update insurance as appropriate. Once you do, the remaining dates will be approved. Failure to update your insurance will mean lead to a rejection of the remaining dates and a termination of facilities use. *If you are a youth sports team organization (as defined in Policy 7510), by signing this form, you are providing a statement of assurance that you meet the insurance requirements set forth in Policy 7510 and that you are in compliance with N.J.S.A. 18A:40-41 et seq. regarding the prevention and treatment of sports-related concussions and head injuries. Setup & Service Requirements Maintenance/Custodial: Please list setup and cleaning requirements and include whether you would like a custodian specifically assigned to your event (please note a fee will apply). The Stafford Township School District reserves the right to assign a specific custodian and charge your organization in accordance with the attached fee schedule if your setup and cleaning requirements so necessitate. In the event this determination is made, you will be notified accordingly. Technology & Equipment: Please list any hardware/software needs along with any specific equipment requirements. Please note there may be a fee associated with certain equipment usage in accordance with the attached fee/cost schedule. Building Usage Times & Fee Information Please be advised that school facilities may not be used during regular school hours. Facilities may only be used after school hours and as a condition for use of the Stafford Township School District facilities all organizations must end their program and vacate the building no later than 10:00 PM. On weekends, organizations may only use the facilities between the hours of 7:00 am and 3:00 pm and must end their program and vacate the building no later than 3:00 pm. The reason is that the custodial staff shift ends at 11:00 PM on weekdays and 4:00 pm on weekends and the remaining time is needed for cleaning of the section of the facility that was occupied. Any group wishing to continue their activity beyond the curfew may do so by indicating same on this Building Use Application. However, the group must do so with the understanding that they will be charged for said usage in accordance with the attached schedule and will be invoiced for same after the event. Further, if a group does not include their extended usage on the application but actually uses the facility for an extended period of time (beyond the regular hours set forth herein), the group will be responsible for the additional cost of extended usage. Please also be advised that the fees discussed herein are only for anticipated use. Should your actual use incur additional fees, you will receive an invoice for actual use after the event in accordance with Policy TLS Application Page 2 of 3

3 Additional Important Information In the event of early dismissal of if schools are closed due to inclement weather, use of the facility will be canceled. Organization Certification The following individual has signed his/her name indicating that he/she has the authorization to complete this Building Use Application for the requesting organization, that the information contained herein is accurate, and that he/she has read the policy and regulation governing use of building (#7510) and understands and agrees to all terms of same, including but not limited to compliance with N.J.S.A. 18A:40-41 et seq. regarding prevention and treatment of sports-related concussions and head injuries for youth sports team organizations. Name (Print): Signature: Contact Information Phone and Address (if different from organization information above): TLS Application Page 3 of 3

4 BUILDING USE APPLICATION FEE/COST SCHEDULE The following is a list of estimated fees/costs for building use in the Stafford Township School District, broken down by the type of group requesting use. Definitions of Class I and Class II Groups can be found in Policy and Regulation Please be aware that these are estimated costs. Special circumstances may cause the estimated fees/costs to change. Should that occur, the group will be notified prior to usage. In addition, these fees/costs do not include additional fees/costs for building repair or additional/excessive cleaning over and above normal cleaning (as set forth in Policy and Regulation 7510). This is not a bill. This is a fee/cost schedule so that groups may estimate their cost of facility use. All groups will be invoiced for fees/costs via a separate invoice. Class I Groups Custodial Fees/Costs When do fees apply? o Fees will apply under any the following circumstances: The organization needs a custodian assigned directly to their event during normal work hours, The custodian must perform extra cleaning (over and above normal routine cleaning) during normal custodial work hours; OR Over and above normal routine cleaning includes but is not limited to cleaning for large groups (50 or more) and cleaning when food/drink is being served. Anytime the organization is using the facility beyond the normal custodial work schedule. o No charge for fees will apply for normal routine cleaning when custodians are on a normal custodial work schedule, Monday through Friday, or for normal routine cleaning when a custodian is scheduled to work on Saturday by the District. Fees (when they do apply): o Monday through Friday Normal Work Schedule (when organization needs a custodian assigned directly to event or for extra cleaning) $30/hour o Monday through Friday Beyond Normal Work Schedule $45/hour o Saturday $55/hour o Sunday and Holiday $70/hour Technology & Equipment Fees/Costs: Since equipment could vary by each group, a use of equipment fee will be determined upon request. Class II Groups Custodial Fees/Costs When do fees apply? o Fees apply to Class II Groups based upon a set hourly rate, per custodian, for all requested use. Fees (when they apply): o Monday through Friday $45/hour per custodian o Saturday $55/hour per custodian o Sunday and Holiday $70/hour per custodian Technology & Equipment Fees/Costs: Since equipment could vary by each group, a use of equipment fee will be determined upon request. Other Fees/Costs: An additional Fee for toiletries of $100 per day will apply. Application Fee/Cost Schedule

5 **IMPORTANT NOTICE** REGARDING AUTOMATED EXTERNAL DEFIBRILLATORS (AEDs) To: Groups Using Stafford Township School District Facilities After School Hours From: Stafford Township School District The Stafford Township School District recognizes lives can be saved with the proper use of Automated External Defibrillators (AEDs). There are, however, certain mandatory procedures which must be followed in order to ensure proper use of these devices. In order to ensure that groups utilizing our facilities after regular school hours have been notified of these mandatory procedures, we offer the following information: Location of AEDs: The following locations within the Stafford Township School District are each equipped with at least one AED: Administration Building Education Center Ocean Acres School Oxycocus School McKinley Avenue School Ronald L. Meinders Primary Learning Center Intermediate School Stafford Township Arts Center We would encourage you to be familiar with the location of the AED so that it can be immediately accessed in the event of an emergency. Mandatory Requirements for Proper Use of AED: According to New Jersey State Law (N.J.S.A. 2A:62A-25, et. seq.), there are certain procedures that must be followed when using the AED: 1. Person using AED must have successfully completed a training program and hold a current certification in cardio-pulmonary resuscitation (CPR) from the American Red Cross, American Heart Association, or other Department of Health and Senior Services approved program. Or, in the alternative, the person using the AED must be licensed by the Department of Health and Senior Services as a Paramedic, Emergency Medical Technician (EMT)-D, or a First Responder-D. 2. Person using the AED must request emergency medical assistance from the appropriate first aid/rescue squad as soon as practicable. We recommend that your group ensure that at all times while using our facilities, there is at least one person from your group that meets the above requirements, so that if an emergency occurs, your group can make use of the AED. Available Resources: If you choose to utilize the AED, it is the responsibility of your group to ensure that the person operating the AED meets the above requirements and follows the proper procedures. However, we will be providing CPR and AED approved training programs to members of our staff and we will make these programs available to your group. If your group would like additional information about this notice or about participating in one of the CPR and AED approved training programs, please call (609) x1276. Application AED Notice