Building Use Form Building Use Form IMPORTANT - This is an application and contract for use of Midland School facilities. If the application is approved, the user agrees to all conditions of the agreement. A copy of this form will be returned to you upon approval or denial by Superintendent. NOTE: A $35 cleaning fee is charged for each building application form. Key deposit of $35 is required for all keys checked out. Will be returned when key is returned and building was in satisfactory condition. Contact Details Name of applicant or organization * Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Person(s) in charge * Address of person(s) in charge * Address of person(s) in charge Address of person(s) in charge Address of person(s) in charge City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Building Information Building to be used * Room(s) to be used * Purpose/reason for use * Attendance number (approximate) Contact phone # Will any special equipment be needed? If yes, what? Event Dates Month Date(s) Year Hours: From To Practice or Rehearsal Dates Month Date(s) Year Hours: From To Event Costs Will admission be charged? Will an offering be received? If charges made or offerings accepted, for what will funds be used? Conditions of Agreement If the request to use school facilities is granted, the user agrees to each of the following conditions: To provide supervision as needed to prevent damage to facilities and/or injury to participants or other people in attendance. To readily make restitution for any property damage incurred as a result of the function as determined by school officials. The user agrees to hold harmless the Midland School District, each individual Board member, and all employees of the Midland District against any and all claims, cost, suits or other forms of liability, and all court costs and attorney’s fees arising out of the use of said facilities. To pay a 35 dollar key deposit, to be refunded in full when key is returned promptly to the issuing administrator. Contact Phone Contact Email Signature Clear Date Internal Use Approved Denied Fee Charged Fee Waived Fee Received Date Key Issued Key # $35 Key Deposit Paid $35 Cleaning Fee Paid Building Principal Signature Dated Building us entered in RSchool Date Entered By Email reCAPTCHA If you are human, leave this field blank. Submit
