Augusta Public Schools - USD 402

Please Fill Out The Facilities Form Below

ALL CONTACT REGARDING FACILITY USAGE REQUESTS WILL BE MADE THROUGH THE ADMINISTRATION OFFICE, 2345 GREYHOUND DRIVE, AUGUSTA, KS. PLEASE NOTE: ALL DISTRCIT FACILITIES ARE LATEX FREE, NO LATEX IS ALLOWED. USERS WILL AGREE TO COMPLY WITH ALL STATE AND FEDERAL LAWS AS IT RELATES TO FACILITY USAGE.

Reaquired field: I agree to not use latex and abide by all State and Federal laws as it relates to facility usage.

REQUESTED BY: Name of Individual Handling Request

Your Email Address

Reaquired field: Street Address

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Phone Number

ORGANIZATION:

IF REQUESTING THE USE OF AN ELEMENTARY SCHOOL, WHICH ONE?

LIST EACH AREA OF BUILDING, AND EACH INDIVIDUAL ROOM(S) BEING REQUESTED:

EQUIPMENT NEEDED (i.e., chairs, tables, lights, sound system, etc. ):

LIST ALL ACTIVITIES TO BE HELD IN FACILITY:

IS THIS A FUND RAISING EVENT?

Reaquired field: NO

Reaquired field: YES

ESTIMATE NUMBER OF PEOPLE ATTENDING:

DATE YOU ARE REQUESTING USE OF FACILITY:

IS YOUR EVENT FOR MORE THAN ONE DAY?

Reaquired field: NO

Reaquired field: YES

ENDING DATE OF FACILITY USAGE:

LIST STARTING AND ENDING TIME OF EACH USE AND INCLUDE SET UP TIME, IF ANY:

ESTIMATED CHARGES FOR USE OF DISTRICT FACILITIES:

Reaquired field: I understand that this is just an estimate

APPROVAL BY BUILDING ADMINISTRATOR

APPROVED BY _____ BOE

LIABILITY INSURANCE

RENTAL

CUSTODIAL/MANAGERAL

LIGHTING

LIGHTING OPERATOR

OTHER ESTIMATED EXPENSES

TOTAL

A FINAL COST STATEMENT OF ACTUAL COSTS WILL BE SENT UPON COMPLETION OF ACTIVITY.

Reaquired field: I understand that a final cost statement will be sent upon completion of activity

WE AGREE TO PAY ANY RENTAL AND CUSTODIAL FEES FOR USE OF THE SCHOOL FACILITY ESTABLISHED BY THE BOARD OF EDUCATION.

Reaquired field: Please check upon agreement

DATE

SIGNATURE OF RESPONSIBLE PARTY

Required Fields

District	Campus	Directory
	CAMPUS