REQUEST FOR USE OF SCHOOL FACILITIES Depew Union Free School District Depew, NY 14043 (716) 686-5088 APPLICATION: (To be submitted a minimum of thirty (30) days prior to requested date) Organization: Facility Requested: Date(s): Areas/Rooms Requested: Time: (start) (end) Assigned Chaperones: 1. 2. 3. Purpose of Activity: Will admission be charged? Yes No If yes, how will proceeds be used? Equipment Requested (ex. Microphone, podium, tables, etc.) : *** For Auditorium and Sports Complex use, a four (4) hour minimum will be charged. AGREEMENT: It is mutually agreed that only the above facilities will be used at the times requested and admission fees, if charged, will be used as stated. The organization also agrees to abide by all policies regarding use of school facilities. Signature of Organization Sponsor or Representative Date Address City/State/Zip Telephone Number APPROVAL/DENIAL: (To be completed by administrators as indicated) District Approval Date Building Approval Date REQUEST APPROVED Date of Approval: REQUEST DENIED Date of Denial: Reason for Denial: OFFICE USE ONLY: Certificate of Insurance on file (attach) prior to use Facilities calendar (Building secretary to enter, check box) Entered: Invoice information to Business Office Lifeguard certifications Pool Permit C: Requestor Building Principal Buildings & Grounds Custodian *: Received Copy of District Pool Plan: Initials
Depew Union Free School District Depew, NY 14043 USE OF FACILITIES FEE SCHEDULE *Fees noted are minimum hourly rates. Rates include basic utilities and basic custodial service. Possible additional charges are listed below. SENIOR HIGH Building/Area of Use Not for Profit For Profit Additional Information (per hour) (per hour) Swimming Pool $24.00 $48.00 Pool permit, lifeguard certifications, insurance required Sports Complex $375.00 $375.00 Daily Fee (not per hour) Full Gymnasium $44.00 $88.00 Each Section (1/2) $24.00 $48.00 Small Gymnasium $24.00 $48.00 Media Center $24.00 $48.00 Auditorium $24.00 $48.00 Plus stage-lighting done by district staff - additional charge Cafeteria (whole) $24.00 $48.00 Each Section (1/2) $12.00 $24.00 Kitchen $15.00 $30.00 Must employ one (1) cafeteria employee Classroom N/A $10.00 MIDDLE SCHOOL Building/Area of Use Not for Profit For Profit (per hour) (per hour) Gymnasium $30.00 $60.00 Each Section (1/2) $22.00 $44.00 Media Center $24.00 $48.00 Cafeteria $24.00 $48.00 Kitchen $15.00 $30.00 Classroom N/A $10.00 Additional Information Must employ one (1) cafeteria employee ELEMENTARY SCHOOL Building/Area of Use Not for Profit For Profit (per hour) (per hour) Gymnasium $30.00 $60.00 Each Section (1/2) $22.00 $44.00 Multi-Purpose Room $24.00 $48.00 Cafeteria $24.00 $48.00 Kitchen $15.00 $30.00 Media Center $24.00 $48.00 Classroom N/A $10.00 Additional Information Must employ one (1) Personal Touch employee Additional Charges 1. Custodial staff required to manage use in addition to regular daily tasks. 2. Weekend use will require any additional costs for overtime labor. 3. If supervision is required time will be billed at $25.00/hr. 4. If use of stage lighting is required, district staff will be assigned at $35.00/hr. 5. No additional charge will be assessed for athletic fields, or other outdoor facilities provided no DUFSD supervisor or maintenance is required. 6. Damage to any area as a result of misuse will be billed at full replacement or repair value. * PLEASE NOTE : PENDING BOARD OF EDUCATION APPROVAL, FEES MAY BE WAIVED FOR ORGANIZATIONS THAT CAN DEMONSTRATE THEIR NOT FOR PROFIT STATUS
Liability - It is understood and agreed that the applicant assumes responsibi1ity for the preservation of order in said bui1ding and liability for any damage or loss of school property and for the District observance of all regulations of the Board of Education with reference to the buildings and grounds. The District will require that all users of the gymnasiums, pool, or athletic fields must have a copy of documentation of liability insurance with a minimum amount of $500,000 on file in the Athletic Office prior to use of facilities, naming the District as an additional insured. Use of the High School pool will require a copy of documentation of a certified lifeguard, with current certification in First Aid and CPR, which must be on file in the Athletic Office prior to use of the pool. A copy of the District's Pool Safety Plan will be sent to each group approved to use the pool. All current certifications must also be with the lifeguard at the pool location. The use of school equipment (computers, overhead projectors, film projectors, VCR's, etc.) should involve an authorized school supervisor or a designee of the District. Any personal injury, damage to the facility or its equipment, or unusual occurrence happening in connection with the organization's use of school facilities must be reported to school authorities immediately or at the start of the next school day. Groups are responsible for payment of damages incurred by their participation and are required to obtain property damage insurance naming the District as an insured. A minimum level of $10,000 is required. Supervision - No organization or group shall be granted the use of any school building facilities unless the organization satisfies the Superintendent of Schools or his/her designee that there wil1 be a responsible person in charge and that there will be adequate supervision provided. Assigned supervisor(s) must be responsible adults, 21 years of age or older, and must be in attendance throughout the entire scheduled time, and shall be required to: Start and end the activity. Report to the building custodian before and after the activity. Keep unauthorized persons out of the assigned area. Confine the activity to the assigned area. Enforce good conduct. Prevent misuse and/or damage to school facilities. Enforce appropriate District rules and procedures as they are listed on the back of the application form, i.e., no smoking, etc. Return assigned equipment in good condition to its proper place. Leave all facilities clean, neat and orderly and in good condition for use the following school day. If locker rooms are used, they must be supervised. If the gym is used, proper footwear must be worn. Responsibility for order and safety must be assured by the applicant. Any damage to school property shall be reimbursed by the organization using the same.
If it is determined that a group using school facilities does not have adequate supervision, then the District will assign supervisory personnel at the District's contractual rate per hour for supervisory personnel. If the group does not wish to pay, then its approval will be revoked. Designated Parking - In order to maintain lawns, edges of roads, safety, etc., all visitors and users of school facilities will be directed not to park along the District's roadways or on grassy areas adjoining parking lots. Designated parking locations for outdoor facilities: SOFTBALL FIELDS: Bus Garage Diamond #1: Bus Garage Diamond #2: Cayuga Diamond #1: Cayuga Diamond #2: Parking is located in front of the Bus Garage. Parking is located at the rear of the High School. Parking is located at the rear of the Middle School. Parking is located in front of Cayuga Elementary School and at the rear of Cayuga Elementary School. BASEBALL DIAMONDS: Cayuga Baseball Diamond: Parking is located in front of Cayuga Elementary School. No parking at the rear of Cayuga Elementary School. Absolutely no cars should be parked on the access road next to the diamonds. This road must be kept open for emergency vehicles. Coaches or managers who are dropping off heavy equipment, etc. should do so and then proceed to park in the designated areas. Coaches and Managers who are holding permits to use District ball diamonds and fields are responsible for directing cars associated with their teams to the proper designated parking areas. The Superintendent of Schools or his/her designee may revoke permits if parking procedures as outlined above are not observed.
RESIDENCY REQUIREMENT - REQUEST FOR USE OF FACILITIES NAME OF ORGANIZATION: PERSON IN CHARGE NAME: PHONE: ADDRESS: (Street) (Town & Zip) The Depew Public Schools in considering your request for utilization of school facilities requests a listing of all personnel in your organization. A minimum of 51% of all participants must reside within the Depew School District for your group to be considered a Group II "Community Organization." The person in charge certifies that the names and addresses of participants submitted on all pages of this request are correctly stated. NAME ADDRESS PHONE NO. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. Signed: