Facility Rental Application

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Building Requested *

Facility or Field Requested *

Date(s) Requested *

Requested Start Time *

Requested End Time *

Estimated Number in Attendance *

Purpose of Rental *

Equipment Items Requested *

Set-Up Requested *

Other Information *

Name of Supervisor in Charge at Rental *

Entrance Fees Charged? *

Yes

Amount charged

In District Group? *

Yes

Percent of Local Residents *

Name of Organization *

Address *

Your Name *

Work Phone

Your Email *

Home Phone *

By Checking this box, I confirm that I have read and understand the Terms and Conditions for Facility Rentals and will abide by the requirements including indemnification of LPCSC. Terms and Conditions can be found at https://drive.google.com/file/d/182dt-swvz7WGzSfE1p_zFxztS48jt0sb/view?usp=sharing *

Agree

Required

Submit

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