KPAC: Facility Use Request
Required form for consideration of Knoxville Performing Arts Center (KPAC) use.  PLEASE NOTE:  Liability insurance is required to rent school facility. Minimum liability requirements: $1 million and Knoxville Community School District listed as an additional insured. Please be sure to read the board policy noted in the form below.
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Checklist prior to completing this form
1. Read Board Policy 1004.1 (linked below) prior to submitting this form.   *Liability Insurance is required to use KCSD facility (specific policy needs:  minimum liability limit of $1 million and Knoxville Community School District as additional insured.)  
2.  Read all questions of this request form before entering your answers.
QUESTIONS about facility availability or other? Email: Ryan.Paulsen@kcsd.k12.ia.us
Organization or Group Name *
Is your organization affiliated with Knoxville Schools? *
(Note: Knoxville School activities and events take priority.)
Required
I agree to using KCSD facilities as outlined in Board Policy 908* (Community Use of School District Buildings, Sites and Equipment). *Facility rules, regulations and fees are listed in this policy for your convenience. *
Required
I agree to using KCSD facilities as outlined in Board Policy 909* (Use of School District Facilities Regulation). *Facility rules, regulations and fees are listed in this policy for your convenience. *
Required
Place of Meeting/Event *
Required
Purpose of Meeting/Event *
(Type of Activity, Event or Sport)
Setup Information (date and time) *
Date(s) Needed *
Please note: The form allows for multiple dates with the SAME start and end TIMES.  If you have varying start times, use separate (additional) forms.  Examples:  Practice 7:00 pm on 5 consecutive Mondays --- One Form.  Practice 5:00 pm on 2 Mondays and 3:00 on Tuesdays --- Two Forms
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Additional Date (2)
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DD
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YYYY
Additional Date (3)
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/
DD
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YYYY
Additional Date (4)
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DD
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YYYY
Additional Date (5)
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YYYY
If more than five dates are needed please list here.  (mm/dd/yy format)
Start Time (When the building needs to be ready including prep time) *
Time
:
End Time *
Time
:
Will you require any special equipment? *
Required
If you are requiring any special equipment, please describe below.
Chairs (#):
Tables (#):
Drop Cords (#):
Microphone (#)
Music stands (#)
Choral risers (# of performers in group)
Choral Sound shells
Piano
Cassette player
CD player
TV/VCR
Computer
Podium
Projection system
Stage Lights
Sound System
Other


List of special equipment *
Contact Name *
Contact Email Address *
Contact Phone Number *
Alternate Phone Number
Name of person/org. to bill *
Street Address (for billing) *
City, State and Zip Code (for billing) *
Is there anything else we should know? Do you have any questions? Other details? Please note  here.
(additional event details)
Damages connected with the use of facilities and/or equipment will be paid for by the person renting the facility.
*Food and drinks are prohibited in the KPAC. This includes rehearsals and performances. Those renting the facility are reminded that you are responsible for assisting with this policy. A reminder to your audience is appreciated. Please *Tape/other adhesives and glitter are not permitted on walls, windows or seats in the KPAC.  
**IMPORTANT: Please email your certificate of insurance** to Ryan.Paulsen@kcsd.k12.ia.us (Specific policy needs:  minimum liability limit of $1 million and Knoxville Community School District listed as an additional insured.)  
new for 2020: Please fill out and email the district use addendum (linked below) to Craig.Mobley@kcsd.k12.ia.us after hitting the submit button below
For Office Use Only
Rental Charge:

Light Technician Hours (x$25/hr):

Sound Technician Hours (x$25/hr):

Facility Supervisor Hours (x$25/hr):

Rigging Technician Hours (x$25/hr):

Custodial Hours (x$25/hr; includes setup and clean-up time):

Piano Fee:  

Date Fees Paid:


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