Lewis-Palmer School District 38 Request for Use of School Facilities

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Date Request is made: Lewis-Palmer School District 38 Request for Use of School Facilities 2015-2016 PLEASE NOTE 2 WEEKS NOTICE IS REQUIRED FOR APPROVAL and approval is not final until an email is received confirming the event. Verbal confirmation of date availability or submission of this document is not a confirmation. Organization: Representative: Mailing Address: City: State: Zip: Phone: Cell: Fax: Email Address: Contact for the day of the event(s): Name Cell phone Purpose/Activity/Event: Number of people anticipated to attend this event, including organizers: Organization s Classifications CAT I D38 Internal Events & Political Caucuses CAT II Established Community Service Sponsored CAT III Non-Profit Tax Exempt # I am including the 501c3 Letter of Determination with this request. CAT IV - Commercial FOR DISTRICT USE ONLY: Proof of Liability Insurance on file: 5013C for Nonprofit Groups on file: APPROVAL: Date of Event Location Approved by District Signature: Date Rc d: Submitted: Approved: Estimate: Invoice: Payment:

Space Requested: Large Meeting Space (Commons) Large Gymnasium Small Meeting Space (Classroom) Small Gymnasium Auditorium/Large Theater Large HS Turf Field Small Performance Space (Black Box) Soccer Field Parking Lot Softball/Baseball Field Practice Room Unimproved Baseball Fields Technology Room Tennis Courts Other School/Building Requested: Grace Best Facility (GBF) Ray E. Kilmer Elementary (KES) Lewis Palmer Elementary (LPES) Palmer Lake Elementary (PLES) Prairie Winds Elementary (PWES) Lewis-Palmer High School (LPHS) Palmer Ridge High School (PRHS) Bear Creek Elementary (BCES) Lewis Palmer Middle School (LPMS) Learning Center (ADMIN) Hours (am/pm) Dates: Days: (Mon, Tue, etc) From: To: # of Hours: FOR INDOOR GENERAL FACILITY USE Tables # Chairs # CD playback DVD projector/screen Lectern and microphone If food will be served, check here and provide more information below. Please note that there may be additional custodial fees related to food service. FOR ATHLETIC SPACE REQUEST ONLY District 38 does not provide any equipment to sport entities unless by special arrangement. Tables # Chairs # CD playback/sound system Scoreboard Bleachers Other requests

FOR AUDITORIUM/PERFORMANCE SPACE USE ONLY Seating for (if space requires set-up of chairs) Performance times (billed at a different rate with ½ hour on each side of performance for audience in the building) Unless specifically requested, no additional equipment or technology will be available to user. Please check below to indicate what additional items need to be determined with the auditorium manager of each site. Tap or clog dancing is restricted unless cleared with the auditorium manager first. The stage floors cannot be marked with anything other than pre-approved spike tape; absolutely no masking tape or packing tape. Lighting Technician (standard lighting package included) $30/hour, additional crew members at $15/hour if deemed necessary by auditorium manager Sound Technician (standard sound package included) $30/hour, additional crew members at $15/hour if deemed necessary by auditorium manager Grand Piano $20/hour, $60 maximum (piano tuning is user s responsibility) Equipment that does not incur an additional fee but must be reserved Music stands # Piano stand lights # Band shell Choral risers # Electric piano keyboard CD playback DVD projector/screen Lectern and microphone Floor microphones # Wireless microphones # Crew headsets # Tables # Chairs # If you need a reception area, please remember to request a commons area as well. Food and drink are not allowed in any performance space. If food will be served, check here and provide more information below. Please note that there may be additional custodial fees related to food service. Other requests

For All Requests I understand that custodial time may be assessed for the full amount of time we use the building depending upon the building s regularly scheduled staff. I also understand that we may be required to pay for clean-up services in addition to rental hours to be billed after the event at $30/hour. I understand that if snow removal is necessary on the day of my rental, I will pay custodial service additional fees for removal. Determination of required snow removal is made by the custodial staff at the school site and by School Services; my responsibility is to make contact with either of those parties ahead of time to determine what must be done and what costs will incur. I understand that for reasons of liability, I cannot remove snow myself. I understand that my entire time on District 38 facilities is requested here, with no preparation time assumed before or after sessions unless I request it as part of my rental. I understand that District 38 is not responsible for altering any facility, including field or gymnasium, in any way unless special arrangements have been made. Spaces will be maintained for school use, but if schools do not have events, no special preparations are included and can be requested for a fee. I understand that Facility Rental will invoice around the 15 th of every month. If my rental extends beyond a month, I will pay the invoices to Facility Rental as I receive them. If my invoices are more than 90 days overdue, I risk losing my reservation this year and may not be approved for rental in the future. I have received, read and agree to all that is outlined in the Combined Use Policy, Community Use of School Facilities. I understand that violation of any of these regulations or an outstanding financial debt to District 38 can result in immediate dismissal from District grounds and refusal of any future requests. I understand that under no circumstances may I sub-lease or allow another group to use the facilities I have rented. I understand that any third party such as an individual, group or organization using school property as provided under this policy shall hold the Board of Education, individual board members and all district officers, agents, and employees harmless from any loss, damage, liability, cost or expense that may arise from the negligence of the third party. Agreed to: (Applicant Signature) Date: I am submitting this document electronically and my typed name above indicates a signature.

Community Use of School Facilities Categories File: KFB / KFC-R Sample Organizations and Categories: Organizations CAT I CAT II CAT III CAT IV School Established Non Profit, Sponsored Community Category II Commercial & Political Sponsored Large Caucuses events* No Fee Custodial Fee Only Fee + Custodial (see rate schedule) D38 Schools X X Churches X X Scouts X X Service Organizations X X Community Youth Sports X X Municipalities X X Homeowners X X Political Caucus X X General Use- Profit X X Utility Co. Boards X X Adult Sports X Leagues Fire-Police X X Any organization or individual, regardless of classification, will be required to pay the cost of custodial services if use of the facility would result in direct costs to the school district. A fee is charged if the facility is used at any time when school personnel are not on duty, primarily on weekends. Additional custodial time will be charged when the activity leaves the building in such a condition that additional clean-up must be performed. For those facilities where a custodian is regularly on duty during the rental, the user will be charged a custodial fee of $30 to compensate for additional work required in set-up, opening, securing, cleaning, etc., related to the rental. If an organization is not listed, Community Schools will determine the category and fee structure. The type of activity conducted in the buildings may change the category of an organization. Requests for community use will be coordinated through Community Schools department. Each building will have a designated staff member to act as a liaison and confirm scheduling of facilities. Custodial and/or event staff will be arranged and pre-approved through Facilities Direct. *Community-sponsored groups who wish to hold large multi-group or state-wide events will be subject to Category III fees. Determination of the conditions under which community groups are subject to rental is determined by the Superintendent/designee. X Revised: July, 2011 Approved: September 15, 2005 Revised: August 2011 Revised: June 2014

Community Use of School Facilities Rate Schedule: (all rates are hourly) Facility Area CAT I CAT II CAT III CAT IV Indoor Large Gymnasiums NC NC $30 $45 Small/Auxiliary Gyms NC NC $30 $45 Small Meeting Areas NC NC $25 $40 Large Meeting Areas (Commons) Lewis-Palmer High NC NC $45 $75 Palmer Ridge High upper NC NC $40 $70 Palmer Ridge High lower NC NC $45 $75 Bear Creek Elementary NC NC $60 $85 Lewis Palmer Middle NC NC $45 $75 Elementary NC NC $30 $45 Auditoriums/Performance Spaces Lewis-Palmer High Auditorium (seats 500) Rehearsal Rate $50 $50 Performance Rate $50 $150 (To include a half hour prior to and half hour after the performance) Palmer Ridge High Auditorium (seats 720) Rehearsal Rate $50 $50 Performance Rate $50 $160 Palmer Ridge High Black Box (seats 120 max) Rehearsal Rate $35 $35 Performance Rate $35 $80 (To include a half hour prior to and half hour after the performance) Minimal use rate with no technical requirements - $60 per event for 3 hour service Don Breese Stadium $60 $85 Breese Field Lights $20 $25 PRHS Turf Field $40 $60 Large football-sized fields NC NC $30 $45 Soccer fields NC NC $30 $45 Softball fields NC NC $30 $45 Tennis Courts NC NC $15 $30 Unimproved baseball fields NC NC $20 $30 Parking lots Determined contract-to-contract, contact Community Schools Rental hours include all hours in the facilities to include setup and tear down. The rate schedule does not include custodial time. All organizations will be charged custodian s time if the facility is used when the school personnel are not normally on duty and the custodian must be available to open and close the building. Additional custodial time will also be charged when the activity leaves the building in such a condition that additional clean-up must be performed. For those facilities where a custodian is regularly on duty during the rental, the user will be charged a custodial fee of $30 to compensate for additional work required in opening, securing, cleaning, etc., related to the rental. Snow removal will be charged for use after hours and at times when school is not is session. It is at the determination of the District if snow removal is required. Revised: June 2014