APPLICATION FOR USE OF NASD FACILITIES

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1 NORRISTOWN AREA SCHOOL DISTRICT ADMINISTRATION SERVICE CENTER 401 NORTH WHITEHALL ROAD NORRISTOWN PA Operations Department Fax APPLICATION FOR USE OF NASD FACILITIES Revised 7/2010

2 PLEASE PRINT NORRISTOWN AREA SCHOOL DISTRICT 401 NORTH WHITEHALL ROAD NORRISTOWN PA APPLICATION FOR USE OF FACILITIES Please complete this form and return one copy to the above address or fax to: Attention: Mr. Robert Malkowski Building/Site Requested: Name of Organization: Address of Organization: Type of Organization: Non-Profit (Must attach copy of IRS Determination Letter for 501(c) 3 status to receive non-profit rates) Commercial Contact Persons (please list two): NAME ADDRESS _ NAME _ ADDRESS _ PHONE: WORK # HOME # PHONE: WORK # HOME # Billing Address (if different than above) Contact address: NAME ADDRESS CITY, STATE ZIP CODE DATE(S) OF EVENT: TIME OF EVENT: _ START END _ WILL ADMISSION BE CHARGED? YES COST NO ESTIMATED NUMBER OF PEOPLE ATTENDING EVENT: HOW WILL PROCEEDS BE USED? BRIEFLY DESCRIBE THE EVENT: 2

3 NORRISTOWN AREA SCHOOL DISTRICT REGULATIONS GOVERNING THE USE OF THE NORRISTOWN AREA SCHOOL DISTRICT FACILITIES I. GENERAL 1. The School District will determine the number of school employees required to service the event. Any objection by the User must be communicated to the District at least seven (7) days prior to the event. NO ADJUSTMENT OR REDUCTION IN FEES WILL BE PERMITTED AFTER THE DAY OF THE EVENT. 2. If a prepayment is required, a deposit of fifty percent (50%) of the estimated charges MUST be received by the District Office prior to the event. The estimate of charges will be included in your confirmation letter. If the rental agreement is cancelled by either party, such deposit will be returned LESS any expenditures incurred by the District. 3. The District will invoice the balance of the charges after the event. Payment is due upon receipt. 4. Certain school organizations have been given exclusive rights to all concession stand sales anytime school facilities are used. A waiver must be obtained by the User from the school organization before the User can sell concessions. 5. See complete listing and map locations of A.E.D. s located in all District facilities. 6. Hold Harmless/Indemnification: THE LESSEE shall indemnify, hold harmless and defend, the NORRISTOWN AREA SCHOOL DISTRICT and its board of school directors, officers, agents, employees and attorneys, in either their official or individual capacities, from and against any and all loss, damage, liability, claims, suits, judgments, and demands whatsoever (INCLUDING reasonable attorneys fees) arising from: any injury to, or death of, any person or persons, or damage to property, arising out of or caused or claimed to have been caused by acts or omissions of THE LESSEE, any subcontractor, employee, agent, member, volunteer or invitee of THE LESSEE, or any other person or entity directly or indirectly employed by any of them, whether or not caused in whole or in part, by actions or omissions of the NORRISTOWN AREA SCHOOL DISTRICT, its agents, employees or officials, or any representative of the NORRISTOWN AREA SCHOOL DISTRICT; provided, however, that if any injury to or death of any person or persons, or damage to property, arises out of any actions or omissions of the NORRISTOWN AREA SCHOOL DISTRICT, its agents, employees or officials, or any representative of the NORRISTOWN AREA SCHOOL DISTRICT, then the indemnity required by this AGREEMENT by THE LESSEE shall be proportionately reduced taking into account the relative degree of responsibility of THE LESSEE, its agents, employees, members, volunteers, licensees and representatives, and of the NORRISTOWN AREA SCHOOL DISTRICT and its agents, employees, and representatives. II. INSURANCE Every organization or individual requesting use of any school facility is required to have insurance. The Certificate of Insurance must be completed and sent to: Mr. Robert Malkowski, Norristown Area School District, 401 North Whitehall Road, Norristown, PA 19403, fourteen days prior to the event. The Certificate of Insurance is subject to the following guidelines: 1. Minimum Liability Limits are: $1,000,000 Combined Single Limit. 2. Products Liability: only required if food will be sold and/or served. 3. Automobile Liability: only required if vehicles of organization or individual renting facilities will be on school district property. 4. Workers Compensation: only required if organization or individual renting facilities has employees. 5. The Certificate MUST say THE NORRISTOWN AREA SCHOOL DISTRICT is an additional insured in regards to (program name) being held on (list dates) at (school name). 3

4 III. RESTRICTIONS 1. No alcoholic beverages or controlled substances are permitted on the Norristown Area School District property at any time. 2. Parking of cars on paved areas only. 3. No Carnivals, Circus, or similar events will be permitted. 4. No inflatable rides or similar rides permitted. 5. No animals, domestic or otherwise, are permitted. 6. No open flame/cooking apparatus will be permitted at anytime. IV. CERTIFICATION I,, being an authorized officer of the, certify that I have read and understood the regulations governing the use of the Norristown Area School District s facilities; and, that I understand and agree to provide the insurance required by the School District; and, that I understand and accept the fees which will be due to the School District for the use of the facilities. Signature Name (please print) Organization Address City, State, Zip Code Telephone/Cell Phone Fax Number address 4

5 Location Requested: Area(s) to be used: (check all that apply) Check Check Check Check Auditorium Cafeteria Locker Rooms Library Dressing Rooms Gym Classrooms Grounds Showers Kitchen Equipment to be provided by NASD: (check all that apply) Check Check Estimated Cost PA System ($50.00) Stage Lighting ($15.00/hr) Microphone ($20.00) Recording Equipment ($10.00) Projector ($20.00) Chairs (no charge) Projection Screen ($10.00) Tables (no charge) VCR/TV ($20.00) Stage Risers Other (describe below) Other : Charges: (fee covers hourly use) High School Non-Profit Commercial Estimated Cost Auditorium/Gym $ $ Cafeteria $ $ Classroom $50.00 $ Classroom with Smartboard $65.00 $ Fields and/or Tennis Courts $40.00 $80.00 Middle and Elementary Schools Auditorium/Gym/Cafeteria $ $ Classroom $50.00 $ Classroom with Smartboard $65.00 $ Fields and/or Tennis Courts $40.00 $80.00 Roosevelt Field Field $ $ Field Lights $40.00 $40.00 School Personnel Custodians $40.00 $40.00 Stage Supervisor $30.00 $30.00 Stage Crew Chief $15.00 $15.00 Stage Crew $9.00 $9.00 Estimated Cost Total: 5

6 A.E.D. Locations It is important that you familiarize yourself with the location of the A.E.D. in the Building(s) you will be using. (Please remove from Application and Keep for your Records) Administration Building: 1) Main Reception Area next to Receptionist s Desk High School 2) First Floor Hallway across from Nurse s Office next to Lobby 3) First Floor in Cafeteria Stairwell #3 4) Gym Lobby by pay phones 5) Athletic Trainers Room Front of Large Gym Roosevelt 6) First Floor Hallway across from Nurse s Office and Room 4 Eisenhower 7) First Floor Hallway across from Main Office 8) Boys Gym Hallway across from Boys Locker Room Door Stewart 9) First Floor Hallway across from Nurse s Office next to Room ) Second Floor Hallway between Boys & Girls Gym East Norriton 11) Hall Exit on Girls side of Gym 12) Hall Outside Multi-purpose Room Atrium Side Whitehall 13) Main Lobby next to Office Door Paul V. Fly 14) First Floor Hallway outside Nurse s Office and Room 1 Gotwals 15) First Floor Hallway across from Main Office Marshall Street 16) Main Lobby Office side of main doors 17) Gym Lobby by water fountain Hancock 18) Main Lobby next to Library Door Cole Manor 19) Main Lobby opposite Glass Atrium Area \\teachfiles2\users\maintenance-business\appforuse doc 6

APPLICATION FOR USE OF PROPERTY AND FACILITIES

- APPLICATION FOR USE OF PROPERTY AND FACILITIES Instructions and Guidelines 11/23/2011 APPLICANT INSTRUCTIONS FOR USE OF PROPERTY OR FACILITIES 1. Once you have received the Application for Use of Property