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  • Brett Saucier

KF-E1

Policy KF-E1


MSAD #60

Berwick, North Berwick & Lebanon FACILITIES USE FORM Today’s Date: ________________




Building Requested To Be Used: ❑ Noble High School ❑ Other School Building: ___________________


Group Type: Noble High School MSAD #60 Noble Community Non-Profit

Other Non-Profit For Profit / Business

Facility(s):


_____ Large Gym _____*Auditorium _____ Cafeteria _____ Classroom(s)

_____ Small Gym _____*Lecture Hall _____*Kitchen _____*Computer Lab

_____ *Weight Room _____*Library _____*Restaurant _____*Project Room

_____ *Cardiovascular Room _____ Box Office _____ Concession Stand _____ Dressing Rooms

_____ Field(s):_____________________________


* School trained personnel must be present. See reverse rate sheet.

  • AED Locations located and marked in each of the schools.

Name of person in charge of event: ______________________________________________________________________________ Mailing Address: _______________________________________________________________________________________________ Cell Phone: __________________________ Work Phone:__________________________ Home Phone:______________________ Name of Contact Person: _________________________________ Cell Phone: __________________________ WorkPhone:__________________________ Home Phone:______________________ E-MailAddress:_______________________________________________________

Liability Insurance Company: ____________________________________________________________________________________

Insurance Policy/Certificate Number: _______________________________________________________________________________

I understand the contract information on the following pages and will take any responsibility for damages or disarray that may occur and agree to pay all fees within fifteen (15) days of receipt of the bill.


________________________________________________________ _____________________

Signature(s) Date

*****************************************************************************************

OFFICE USE ONLY


Approved: _______ Not Approved: ________ Liability Insurance: ________ Copy On file: _______ yes _______ no Requirements: Custodian(s): ________ Kitchen Staff: ________ Police: _________

Medical Personnel / Athletic Trainer: _________ MSAD#60 Trained Employee: _________ Event Manager: _________



Approving Manager______________________________________ Date__________________________

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Superintendent

Audra Beauvais

Assistant

Superintendent

Susan S. Austin

Phone: 207-676-2234

Fax: 207-676-3229

100 Noble Way, North Berwick, ME 03906

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