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NORTH SANPETE SCHOOL DISTRICT
FACILITY USER REQUEST FORM AND PERMIT

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This user request form is required for use of North Sanpete School District Property. This is not a confirmation of your request. Once received by North Sanpete School District, we will reply as soon as possible. If your request is approved for use as a Civic Center below, it will constitute a permit for use of this property pursuant to UCA. ยง 53A-3-413,414. The School District is thereby not liable for any claims, injuries, or lawsuit arising from use of District property under UCA 63G-7-301(5). 

Name: _____________________________________________________  Date:_______________________
                               (person/group requesting facility to be used)

Date needed: __________________________               Starting time: _____________________

Approximate number of participants: _______               Closing time:  _____________________

For Profit Organization? _______ If yes, a certificate of insurance must be provided.

Non Profit? _______ If yes,  a 501c3 form must be provided.

Are you an employee of North Sanpete School District?  _____   If yes, a signed UA Code R277-107 form must be included.

Indemnity Agreement _________ (available by clicking here)               Proof of Liability Insurance _________

Please mark which facilities you wish to reserve:

Auditorium  _______________ Classroom _______________
Commons _______________ Field Areas _______________
Gymnasium _______________ Library _______________
Kitchen _______________ Other _______________

 

 

 


Conditions:

  • A responsible person (21 or older) must be supervising events, participants and spectators at all times. All applicable laws, policies, and guidelines must be followed. Employees must stay with the event until finished, cleaned and locked-up.
  • Care and maintenance of facilities must be guaranteed to include trash cleanup (building and grounds) lawn care field repair or remarking, return of all equipment, etc.
  • School events have priority.
  • Damages will be assessed at actual cost. Refund may be held to cover costs.
  • A school lunch employee is required to assist when the kitchen area is requested. You will need to make arrangements with lunch supervisor for assignments of lunch personnel. Their salary must be added to the fee.
  • Other______________________________________________________________________________


Supervisor/Contact Person: ____________________________________ Phone:___________________  

Address:_______________________________________________________________________________

Type of Activity:_________________________________________________________________________

Signature:___________________________________________________  Date:  _____________________


Deposit/Fee Schedule:

Deposit $100 refundable, if all conditions are met
Rental Fee _____________ (refer to building rental fee schedule)
Supervisor Fee $30 per hour (for each supervisor needed)
Custodial/Kitchen Fee $30 per hour (for each custodian needed)
Technician Fee $7.25 per hour for each technician + $5 for mic.
Total Deposit/Fees _____________

 

 

 

 

 


PERMIT

 Your request has been approved for use of District property at (location)____________________________
___________________________________ at these times: ______________________________________.

               Approved by: _____________________________________  Date: __________________________